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Full text of "North Carolina Register v.3 no. 20 (1/16/1989)"

J i^BR l<FU/7^3^/.hl^^ro0'7 



RECEIVED 
]AN 19 1989 



^W LIBRARY 



The 
NORTH CAROLINA 

REGISTER 



IN THIS ISSUE 



Til 



ADMINISTRATIVE ORDER 

FINAL DECISION LETTERS 

PROPOSED RULES 

Human Resourses 

N.C. Board of Nursing 

NRCD 

State Personnel 

LIST OF RULES AFFECTED 

ISSUE DATE: JANUARY 16, 1989 



Volume 3 • Issue 20 • Pages 873-988 



INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE 



NORTH CAROLINA REGISTER 

The North Carolina Register is published bi-monthly 
and contains information relating to agency, executive, 
legislative and judicial actions required by or affecting 
Chapter 150B of the General Statutes. All proposed, ad- 
ministrative rules and amendments filed under Chapter 
150B must be published in the Register. The Register 
will tvpically comprise approximately fifty pages per 
issue of legal text. 

State law requires that a copy of each issue be pro- 
\'ided free of charge to each county in the state and to 
\arious state officials and institutions. The North CaroUna 
Register is a\ailable by yearly subscription at a cost of 
one hundred and five dollars ($105.00) for 24 issues. 

Requests for subscriptions to the North Carolina 
Register should be directed to the Office of Ad- 
ministrative Hearings, P. O. Drawer 1 1666, Raleigh, N. 
C. 27604, Attn: Subscriptions. 

ADOPTION, AMENDMENT, AND REPEAL OF 
RULES 

An agency intending to adopt, amend, or repeal a rule 
must first publish notice of the proposed action in the 
North Carolina Register. The notice must include the 
time and place of the public hearing; a statement of how 
public comments ma\' be submitted to the agency either 
at the hearing or otherwise; the text of the proposed 
rule or amendment; a reference to the Statutory 
Authority for the action and the proposed effecti\e date. 

The Director of the Office of Administrati\'e Hearings 
has authority to publish a summary, rather than the 
full text, of any amendment which is considered to be 
too lengthy. In such case, the full text of the rule con- 
taining the proposed amendment will be available for 
public inspection at the Rules Di\ision of the Office of 
Administrative Hearings and at the office of the pro- 
mulgating agency. 

Unless a specific statute provides otherwise, at least 
30 days must elapse following publication of the pro- 
posal in the North Carolina Register before the agency 
may conduct the required public hearing and take ac- 
tion on the proposed adoption, amendment or repeal. 

When final action is taken, the promulgating agency 
must file any adopted or amended rule for approval by 
the Administrati\'e Rules Re\iew Commission. Upon ap- 
proval of ARRC, the adopted or amended rule must be 
filed with the Office of Administrati\'e Hearings. If it 
differs substantially from the proposed form published 
as part of the public notice, upon request by the agen- 
cy, the adopted version will again be published in the 
North Carolina Register. 

A rule, or amended rule cannot become effective 
earlier than the first day of the second calendar month 
after the adoption is filed \\ith the Office of Ad- 
ministrative Hearings for publication in the NCAC. 

Proposed action on rules may be withdrawn by the 
promulgating agency at any time before final action is 
taken by the agency. 

TEMPORARY RULES 

Under certain conditions of an emergency nature, 
some agencies may issue temporary rules. A temporary 
rule becomes effective when adopted and remains in 



effect for the period specified in the rule or 180 day 
whichever is less. An agency adopting a temporary ru 
must begin normal rule-making procedures on the pe 
manent rule at the same time the temporary rule 
adopted. 

NORTH CAROLINA ADMINISTRATIVE CODE 

The North Carolina Administrative Code (NCAC) 
a compilation and index of the administrative rules 
25 state agencies and 38 occupational licensing boarc 
The NCAC comprises approximately 15,000 letter siz 
single spaced pages of material of which approximat 
ly 35 ?o is changed annually. Compilation and public 
tion of the NCAC is mandated by G.S. 150B-63(b) 

The Code is divided into Titles and Chapters. Ea( 
state agency is assigned a separate title which is fi 
ther broken down by chapters. Title 21 is designat 
for occupational licensing boards. 

The NCAC is available in two formats. 

(1) Single pages may be obtained at a minima 
cost of two dollars and 50 cents ($2.50) for 
pages or less, plus fifteen cents ($0.15) per ea 
additional page. 

(2) The full publication consists of 52 voIuok 
totaling in excess of 15,000 pages. It is si 
plemented monthly with replacement pages 
one year subscription to the full publication 
eluding supplements can be purchased f 
seven hundred and fifty dollars ($750.00). 1 
di\idual \olumes may also be purchased wi 
supplement ser\ice. Renewal subscriptions f 
supplements to the initial publication availab 

Requests for pages of rules or volumes of the NC^ 
should be directed to the Office of Administrati 
Hearings. 

NOTE 

The foregoing is a generalized statement of the pi 
cedures to be followed. For specific statutory languaj 
it is suggested that Articles 2 and 5 of Chapter 150B 
the General Statutes be examined carefully. 

CITATION TO THE NORTH CAROLINA 
REGISTER 

The North Carolina Register is cited by volume, issi 
page number and date. 1:1 NCR 101-201, April 1, 19 

refers to Volume 1, Issue 1, pages 101 through 201 
the North Carolina Register issued on April 1, 198i 



North Carolina Register. Published bi-monthly by 
the Office of Administrative Hearings, P.O. Drawer 
11666, Raleigh, North Carolina 27604, pursuant to 
Chapter 150B of the General Statutes. Subscriptions 
one hundred and five dollars ($105.00) per year. 
North Carolina Administrative Code. Published 
in looseleaf notebooks with supplement sen'iceby 
the Office of Administrative Hearings, P.O 
Drawer 1 1666, Raleigh, North Carolina 27604, pur- 
suant to Chapter 150B of the General Satutes. 
Subscriptions seven hundred and fifty dollars 
($750.00). Indi\idual volumes available. 



NORTH 
CAROLINA 
REGISTER 



ISSUE CONTENTS 




Office of Administrative Hearings 

P. O. Drawer 11666 

Raleigh, AC 27604 

(919) 733-2678 



Robert A. Mclott, 

Director 
James R. Scarcella Sr., 

Deputy Director 
Molly Masich, 

Director APA Services 



Staff: 

Ruby Creech, 

Publications Coordinator 
Teresa Kilpatrick, 

Editorial Assistant 
Jean Shirley, 

Editorial Assistant 



I. ADMINISTRATIVE ORDER 

Administrative Order 873 



II. FINAL DECISION LETTERS 

Voting Rights Act 877 



III. PROPOSED RULES 
Human Resources 

Health Services 879 

Mental Health 890 

Services for the Blind 948 

Social Services Commission 949 

Licensing Boards 
Nursing, Board of 965 

NRCD 

Departmental Rules 954 

Environmental Management.... 960 
Wildlife Resources 
Commission 961 

State Personnel 
Office of State Personnel 971 

rv. LIST OF RULES AFFECTED 

January 1, 1989 976 

V. CUMULATIVE INDEX 985 



NORTH CAROLINA REGISTER 

Publication Deadlines and Schedules 

(January 1989 - May 1990) 



Issue 


Last Day 


Last Day 


Earliest 


* 


Date 


for 


for 


Date for 


Earliest 




Filing 


Electronic 


Public 


Effective 






Filing 


Hearing & 
Adoption by 
Agency 


Date 


+++*++♦+ 


+++♦++++ 


++♦+*♦+♦ 


♦+♦♦++♦+ 


♦*♦♦♦++< 


01,02,89 


12,-08 88 


12,15/88 


02/01/89 


05/01,89 


01,16/89 


12 '27/88 


01,03,89 


02/15/89 


05/01/89 


02,-01,89 


orio 89 


01/17/89 


03/03/89 


06 '01 89 


02,15 89 


01 26 89 


02 02,89 


03,' 17 89 


06 01,89 


03 01 89 


02 08 89 


02/15/89 


03/ 31, '89 


0701 89 


03 15 89 


02 21 89 


03, 02/89 


04/ 14 89 


07,01,89 


04 03 89 


03 10 89 


03 17 89 


05/03/89 


08/01,89 


04, 14 89 


03 23 89 


03 31/89 


05/ 14 '89 


08/01 89 


05 01 89 


04 10 89 


04 17/89 


05 31/89 


09/0 r 89 


05 15 89 


04 24 89 


05 01,89 


06 14 '89 


09 01 89 


06 0189 


05 10 89 


05 17/89 


07 01,89 


10,01 89 


06 15; 89 


05 2489 


06 01,89 


07/15/89 


10/01/89 


07 03,89 


06 12 89 


06 19 89 


08,01/89 


11 01 89 


07,14 89 


06 22 89 


06 29 89 


08/ 13/89 


11,01 89 


08 0189 


07 11,89 


07,18/89 


08/31 '89 


1201 89 


OS 15 89 


07 25 89 


08 01 89 


09 14 89 


12 01 89 


09 01,89 


08 11 89 


08 18 89 


10 01 89 


01 01 90 


09,15,89 


OS 24 89 


08 31,89 


10,15/89 


01,01 90 


10 02/89 


09 11 89 


09 18 89 


11/01/89 


02 01 90 


10 16 89 


09 25 89 


10 02 89 


11/15/89 


02,01 90 


11/01/89 


10 11 89 


10 18 89 


12/01/89 


03/01, 90 


11 15 89 


10 24 89 


10 31 89 


12 15 89 


03 01 90 


12 01 89 


11 07 89 


11 15 89 


12 31 89 


04 01 90 


12,15/89 


1 1 22 89 


12 01 89 


01,' 14, 90 


04 01 90 


01 0290 


12 07 89 


12 14 89 


02,0 L 90 


05,01 90 


01 1690 


12 20 89 


12 29/89 


02/15 90 


05 01 90 


02 01 90 


01 10 90 


01 18/90 


03/03/90 


06/01 90 


02 15 90 


0125 90 


02 01 90 


03/17/90 


06'0r90 


03 01,90 


02 08 90 


02 15 90 


03,31/90 


07,01 90 


03 15/90 


02 22 90 


03,01/90 


04,14,90 


07,01 90 


04 02 90 


03 12 90 


03 19 90 


05/02/90 


08/01 90 


04 16/90 


03 23 90 


03 30 90 


05/16/90 


08 01 90 


05,01/90 


04 09 90 


04 17 90 


05/31/90 


09 01/90 


05 15 90 


04 24 90 


05 01 90 


06 14 90 


09 01 90 



* The "Earliest Effective Dale" is computed assuming that the public hearing 
and adoption occur in the calendar month immediately following the "Issue 
Date", that the agency files the rule with The Administrative Rules Review 
Commission by the 20th of the same calendar month and that ARRC approves 
the rule at the next calendar month meeting. 



ADMINISTRA TIVE ORDER 



STATE OF NORTH CAROLINA IN THE OFFICE OF 

I ADMINISTRATIVE HEARINGS 

WAKE COUNTY 



ORDER 



Under the provisions of G.S. 150B-63(dl) it is hereby ordered that the memorandum to all 
agency heads and Administrative Procedures Act coordinators entitled "Possibly Invalid Rules" 
and dated January 6, 1989, be published in the North Carolina Register. 



This the 6th day of January, 1989. 



s/Robert A. Mclott 



Chief Administrative Law Judge 
Director. 



NOR TH CA ROLINA REGIS TER 8 73 



ADMimSTRA TIVE ORDER 



MEMORANDUM 

TO: Agency Heads and APA Coordinators 

FROM: Robert A. Melott 

Director, Office of Administrative Hearings 

RE: Possibly Invalid Rules 

I. Background 

G.S. 150B-59(c) reads in part: 

"Rules adopted by an agency subject to the provisions of Article 2 of this 
Chapter in effect on September 1, 1986, that do not conflict with or violate the 
provisions of G.S. 150B-9(c) shall remain in effect untU July 15, 1988. These 
rules are repealed effective July 16, 1988, unless the Administrative Rules Re- 
view Commission determines that a rule complies with G.S. 
143B-30.2(a)....[The statute then provides for extension of the repeal date for 
certain agencies.) Review of these rules shall be carried out in the maimer pre- 
scribed in G.S. 143B-30.2 except that a rule determined to be in compliance 
shall remain in effect. In the event of rules which the Commission determines 
do not comply with G.S. 143B-30.2, such rules may be revised or repealed by 
the agency without a rulemaking hearing in accordance with G.S. 1 SOB- 12(h). 
Revised rules shall be returned to the Commission. If the Commission ap- 
proves the rules the Commission shall notify the agency and file the rules with 
the Office of Administrative Hearings...." [Emphasis added.] 

G.S. 150B-12(h) reads m pertinent part; 

"No rule making hearing is required to amend or repeal a rule to comply 
with G.S. 143B-30.2 in accordance with G.S. 150B-59(c)." [Emphasis added.] 

Certain rules filed by the Administrative Rules Review Commission in accordance with G.S. 
150B-59(c) during the last week of December brought to my attention for the first time deviations from 
the provisions of the statutes quoted that may invalidate the rules recently filed and others filed and 
codified in the past. 

This problem does not affect rules in effect on September I , I9S6. and not amended after that date. 
It affects new rules that became effective after September 1, 1986, and possibly rules that existed on that 
date that were amended after that date. 

It is my opinion that the statutes quoted clearly do not give authority for an agency to adopt a new 
rule without public hearing, and that any such adoption is invalid. 

This proposition seems clear in that G.S. 150B-59(c) does not give authority to ARRC to review 
rules not in effect on September 1, 1986, as part of its review of existing rules and neither G.S. 
150B-59(c) nor G.S. 150B- 12(h) provides for adoption without public hearing. 

It is my further opinion that serious questions can be raised as to the validity of amendment or 
repeal of rules without public hearing, relying on G.S. 150B-59(c) and G.S. 150B-12(h), if the rule ex- 
isted on September 1, 1986, but was amended thereafter. 

This proposition is less clear. WTiile the exception as to amendments and repeals without public 
hearing is cxpUcit, an argument can be made that ARRC has no need or authority to review under 
G.S. 15nB-59(c) a rule that is has already reviewed under G.S. 143B-30.2. Any rule in existence on 



S74 NOR TH CA R OLINA REGIS TER 



ADMINISTRA TIVE ORDER 



September 1, 1986, but amended thereafter, has been subject to review when the amendment was ap- 
proved by ARRC. "The filing on an amendment to a rule places the entire rule before the Commission 
for its review." G.S. 143B-30.2(h). Whether the review of a rule during consideration of the amend- 
ment takes that rule out of the coverage of G.S. 150B-59(c) and therefore invalidates even amendments 
or repeals effectuated without public hearing may be of concern to the promulgating agency. 

In addition to the foregoing, I have received information, which as yet I have not had time to 
substantiate, that in some instances agencies or the ARRC staffer both have, by reusing numbers, in- 
cluded what are in fact new rules in what were represented to be amendments to existing rules and 
thereby circumvented the requirement for public hearing. It is possible that some such items have been 
codified. An audit of all filings relying on G.S. 150B-59(c) is being conducted to determine whether 
this has in fact occurred and if so what rules are involved. 



II. OAH Action 

1. In regard to filings that have not been accepted and codified (i.e., any approvals by ARRC at 
its December, 1988, meetmg and thereafter); 

a. Any filing that constitutes an adoption, that is, a "completely new rule with a new rule 
number," 26 NCAC 2.\ .0201, that has not been the subject of notice in the North Carolina 
Register, public hcanng, and all other requirements of Article 2 of Chapter 150B will not be 
accepted. 

b. Any filmg that is an amendment or repeal of a rule that was in effect on September 1, 1986, 
but amended thereafter, where such filing claims the exemption from public hearing given by 
G.S. 150B- 12(h) and G.S. 150B-59(c), wiU be accepted. The original filing will be placed in the 
permanent file with a notice, and such notice will be added to the history' note, as follows: 

"(This rule) (This repeal) in whole or in part may be invalid due to the failure 
of the adopting agency to comply with Article 2 of Chapter 150B. The adopt- 
ing agency has relied on the exemption to the public hearing requirement con- 
tained in G.S. 150B-12(h) and G.S. 150B-59(c). It is the opinion of the 
Director of the Office of Administrative Hearings that those provisions do not 
apply to all or part of this rule. The adopting agency asserts the validity of (the 
rule) (the repeal) despite that opinion." 

2. All items already codified relying on the exemptions are being reviewed as time and staff avail- 
ability pennit. /Vny new rule, amendment or repeal that is found that comes within any of the 
problem areas discussed herein will have the above notice added to the permanent file and the 
history note. 

3. In connection with 1 and 2, you should be aware, if you are not already, that G.S. 150B-59(6) 

makes my acceptance of a rule for filing prima facie evidence that the filing is proper. The pri- 
mary' purpose of the notice discussed herein is to make public knowledge, by the best means 
available to me, the fact that presumption of validity may be rebuttable as to the rules in ques- 
tion. 



III. Recommended Agency Action 

1. I strongly urge you to consult your legal counsel regarding the contents of this memorandum. 

2. If a decision is made that action should be taken to ensure the validity of any rule, I suggest that 
rulemaking that conforms to the requirements of Article 2 of Chapter 150B should be com- 
menced. Agencies should also consider the possible use of temporary rulemaking as an interim 
measure where appropriate. 



NOR TH CA ROLINA REGIS TER 8 75 



ADMINISTRA TIVE ORDER 



3. Agency heads, agency counsel, and particularly APA Coordinators should, if necessary, famil- 
iarize themselves with the provisions of Chapters 143B and 1 508 regarding the authority and 
responsibility of the ARRC and OAH respectively. 

ARRC is mandated to review the content of certain existing and all rules or proposed rules in 
relation to statutory authority, clarity and need. G.S. 143B-30.2(a) and G.S. 150B-59(c). 

OAH is mandated to assist agencies in drafting rules, G.S. 150B-60(c), and to oversee the filings 
procedures and format of adopted rules, including publication of proposed rules in the North 
Carolina Register, G.S. 150B-59(a) and (b), G.S. 150B-61 and G.S. 150B-63. 

I strongly urge you to determine, when you have a question or problem concerning administrative 
rules, to determine whether that question falls within the ambit of ARRC or OAH and then to obtain 
a response from the agency that has the responsibility and authority to deal with the matter. 



cf; The Honorable John S. Stevens, Chairman 
Administrati\e Rules Review Commission 



876 NOR TH CA ROLINA REGIS TER 



VOTING RIGHTS ACT FINAL DECISION LETTERS 



[G.S. I20-30.9H, effective July 16, 1986, requires that all letters and other documents issued by the 
Attorney General of the United Slates in which a final decision is made concerning a "change af- 
fecting voting" under Section 5 of the Voting Rights Act of J 965 be published in the North Carolina 
Register. J 



U.S. Department of Justice 
Civil Rights Division 

JPT:DBM:ST:dvs:svw 

DJ 166-012-3 Voting Section 

W9600 P.O. Box 66128 

Y0912 Washington, D.C. 20035-6128 

December 23, 1988 

DeWitt F. McCarley, Esq. 

City Attorney 

P. O. Box 7207 

Greenville, North Carolina 27835-7207 

Dear .\Ir. McCarley: 

Tliis refers to the annexation [Ordinance No. 1887 ( 1988)] and the designation of the annexed area 
to a single-member district for the City of Greenville in Pitt County, North Carolina, submitted to the 
Attorney General pursuant to Section 5 of the Voting Rights Act of 1965, as amended, 42 U.S.C. 
1973c. We received your submission on November 4, 1988. 

The Attorney Genera! does not mterpose any objections to the changes in question. However, 
we feel a responsibility to point out that Section 5 of the Voting Rights Act expressly provides that the 
failure of the Attorney General to object does not bar any subsequent judicial action to enjoin the 
enforcement of such chanszes. See the Procedures for the Administration of Section 5 (28 C.F.R. 
51.41). 

Sincerely, 



James P. Turner 
Acting Assistant Attorney General 
Civil Rights Division 



By: 



Barry H. Weinberg 
Acting Chief, Voting Section 



NORTH CAROLINA REGISTER 877 



VOTING RIGHTS ACT FINAL DECISION LETTERS 



U.S. Department of Justice 
Civil Rights Division 

Voting Section 
P.O. Box 66128 
Washington, D.C. 20035-6128 



December 29, 1988 



Michael Crowell, Esq. 

I harrinsiton. Smith & Hargrove 

P. O. Box 1151 

Raleigh, North Carolina 27602 

Dear Mr. Crowell: 

This refers to your request that the Attorney General reconsider the August 1, 1988, objection 
under Section 5 of the Voting Rights Act of 1965, as amended, 42 U.S.C. 1973c, to the change from 
at-large to single-member district elections and the districting plan for the board of education in 
Granville County, North Carolina. 

This also refers to the implementation schedule, including the April 11 and May 2, 1989, special 
elections, for the new election system, submitted to the Attorney General pursuant to Section 5. We 
received your letter and submission on November 4, 1988. 

As indicated in the .August 1, 19SS objection letter, the objection was interposed because we could 
not fmd an\' significant differences, in terms of the opportunities presented to minority voters, between 
the school board plan and the county commission plan, which the United States District Court found 
to violate Section 2 of the \'oting Rights Act, as amended, 42 U.S.C. 1973, in McGhee v. GranvUle 
County, No. 87-29-CIV-5 (E.D.N.C. Feb. 5. 1988). In view of the pending appeal of that decision, 
we noted that if the appeal resulted in a reversal of the McGhee decision, reconsideration and with- 
drawid of the objection could be warranted. 

As your request for reconsideration points out, the United States Court of Appeals for the Fourth 
Circuit has reversed the distnct count. McGhee v. Gran\ille County, No. 88-1553 (4th Cir. Oct. 21, 
1988). Accordingly, pursuant to the reconsideration guidelines promulgated in the Procedures for the 
Administration of Section (28 C.F.R. 51.48), the objection interposed to the single-member district 
election system and districting plan is hereby withdrawn. In addition, the Attorney General does not 
interpose any objection to the 1989 implementation schedule. However, we feel a responsibility to 
point out that Section 5 of the \'oting Rights Act expressly provides that the failure of the Attorney 
General to object does not bar any subsequent judicial action to enjoin the enforcement of such 
changes. See also 28 C.F.R. 51.41. 

Sincerely, 

James P. Turner 
Acting Assistant Attorney General 
Ci\il Rights Division 

By: 

Gerald W. Jones 



S78 NOR TH CAROLINA REGIS TER 



PROPOSED RULES 



TITLE 10 - DEPARTMENT OF HUMAN 
RESOURCES 

l\ otice is hereby given in accordance with G.S. 
I SOB- 1 2 that the Division of Health Services in- 
tends to adopt and amend rules cited as 10 NCAC 
7A .0209, .0211: 8D .0701, .0707; 8G .0904; lOA 
.2119, 2122, .2123, .2129; lOB .1401 - .1403, 
.1501 - .1502, .1601 - .1612; IOC .0314; I OF .0001 
- .0002, .0032 - .0033, .0042; lOH .0201 - .0205. 

1 he proposed effective date of this action is June 
1, 1989. 

1 he public hearing will be conducted at 1:30 
p.m. on February 15, 1989 at the Archdale Build- 
ing, Hearing Room (Ground Floor), 512 North 
Salisbury Street, Raleigh, North Carolina. 

\^ omment Procedures: Any person may request 
information or copies of the proposed rules by 
writing or calling John P. Barkley, Agency Legal 
Specialist, Division of Health Services, P.O. Box 
2091, Raleigh, North Carolina 27602-2091, 
(919) 733-3/34. Written comments on these rule 
changes may be sent to Mr. Barkley at the above 
address. Written and oral comments (no more 
than ten minutes for oral comments) on these rule 
changes may be presented at the public hearing. 
Notice should be gi\'en to Mr. Barkley at least 
three days prior to the public hearing if you desire 
to speak. 

CHAPTER 7 - HEALTH: EPIDEMIOLOGY 

SUBCHAPTER 7A - ACUTE COMMUNICABLE 
DISEASE CONTROL 

SECTION .0200 - CONTROL MEASURES FOR 
COMMUNICABLE DISEASES 

.0209 CONTROL MEASURES 

(d) The following are the control measures for 
the Acquired Immune Deficiency Syndrome 
(AIDS) and Human Immunodeficiency Virus 
(HIV) infection: 

(2) The attending physician shall: 
(C) If the attending physician knows the 
identity of the spouse of an HIV-infected 
patient and has not, with the consent of 
the infected patient, notified and coun- 
seled the spouse appropriately, the physi- 
cian shall list the spouse on a form 
provided by the Division of Health Ser- 
vices and shall mail the form to the di%'i- 
sion; the division will undertake to 
counsel the spouse; the attending physi- 
cian's responsibihty to notify exposed and 



potentially exposed persons is satisfied by 
fulfilling the requirements of (d)(2)(B) and 
(C); 
(3) The attending physician of a child who 
is infected with HIV and who may pose a 
significant risk of transmission in the 
school or day care setting because of 
open, oozing wounds or because of be- 
havioral abnormalities such as biting shall 
notify the local health director. The local 
health director shall consult with the at- 
tending physician and investigate the cir- 
cumstances. 
(A) If the child is in school and the local 
health director determines that there may 
be a significant risk of transmission, the 
local health director shall consult with an 
interdisciplinary committee, which shall 
include appropriate school personnel, a 
medical expert, and the child's parent or 
guardian to assist in the investigation and 
determination of risk. The local health 
director shall notify the superintendent or 
private school director of the need to ap- 
pomt an interdisciplinary committee. If 
the local school system has octabliohod 
establishes such a committee within three 
days of notification, the local health di- 
rector shall consult with tliis committee. 
If the local health director determines that 
a significant risk of transmission exists, the 
local health director shall notify the par- 
ents and the committee and shall assist the 
committee in determining whether an ad- 
justment can - be made to the student's 
school program to eliminate any signif- 
icant risk of transmission. If the local 
health director determines that ef th« Fe- 
quiromont fof an altomato child safe ef 
oducatioiml sotting. alternative educa- 
tional setting is necessary, the local health 
director shall instruct the superintendent 
or private school director concerning ap- 
propriate protective measures to be im- 
plemented in the alternative educational 
setting developed by appropriate school 
personnel, fte local h e alth dir e ctor shall 
notify th» school principal ©f t4*e school 
ef institution chosen hy- the parent ep 
guardian to provide the altomato oduoa 
tional fiuttmg. When the local health di- 
rector determines that a significant risk of 
transmission exists, the local health direc- 
tor shall consult with the superintendent 
or private school director to aft altomato 
educational sotting is requir e d, tfee local 
h e alth diructor shall determine if school 
personnel directly involved with the child 



NORTH CAROLINA REGISTER 



879 



PROPOSED RULES 



need to be notified of the HIV infection 
in order to prevent transmission. The lo- 
cal health director shall determine which 
school personnel shall be notified and 
shall ensure that these persons are in- 
structed regarding the necessity for pro- 
tecting confidentiality. 
(B) If the child is in day care and the local 
health director determines that there is a 
siijiificant nsk of transmission, the local 
health director shall notify the parents that 
the child must be placed in an alternate 
child care settina that eliminates the sig- 



nificant risk of transmission. 



(4) 



When health care workers or other per- 
sons have had a nonsexual blood or body 
fluid exposure that poses a significant risk 
of transmission, the following shall apply: 

(A) ^^^^en the source person is known: 

(i) The attending physician or occupa- 
tional health care provider responsible 
for the exposed person shall notify the 
attending physician of the person whose 
blood or body fluids is the source of the 
exposure that an exposure has occurred. 
If the attending physician of the source 
person knows the source's HIV in- 
fection status, the physician shall trans- 
mit this information to the attending 
physician of the exposed person. If the 
attending physician of the source per- 
son does not know the infection status 
of the source person, the physician shall 
discuss the exposure with the source 
and if the source person is at high nsk 
for HIV infection, shall request permis- 
sion for testing for HIV infection. If 
permission is granted, the source shall 
be tested. If pennission is denied, the 
local health director may order testing 
of the source if the local health director 
determines that the exposure poses a 
significant risk of transmission of HIV 
and that the source is at high nsk for 
HIV infection. Whether or not the 
source is tested, the attending physician 
of the exposed person shall be notified 
of the risk status of the source and their 
infection status, if known. 

(B) WTicn the source person is unknown, 
the attending ph\sician of the exposed 
person shall eive inform the exposed per- 
son of the nsk of transmission Ae control 
moar . uroL' i lir . ted » (d)( 1 )(a) through {^ 
and offer testing for HI\' infection as soon 
as possible after exposure and at reason- 
able inten.'als up to one year to determine 
whether transmission occurred. 



13) A person charged with an offense that 
involves nonconsensual va.ginal, anal, or 
oral intercourse, or that involves vaginal, 
anal, or oral intercourse with a child 12 
years old or less shall be tested for HIV 
infection if 

(A) probable cause has been found or an 
indictment has been issued; 

(B) the victim notifies the local health di- 
rector and requests mformation concern- 
ing the HIV status of the defendant; and 

(C) the local health director determines that 
the alleged sexual contact involved in the 



otTense would 



a significant risk of 



transmission of HIV if the defendant were 
HIV infected. 



If in custody, the person shall be tested by 
the Department of Corrections and if not in 
custody, the person shall be tested bv the 
local health department. The Department 
of Corrections shaU inform the local health 
director of al[ such test results. The local 
health director shall inform the victim of the 
results of the test, counsel the victim appro - 
pnatelv, and instruct the victim regarding the 
necessity for protecting confidentiality. 

Statutory Authority G.S. 1 30 A- 144. 

.0211 Dl TIES OF OTHER PERSONS 

(b) The following persons shall require that any 
person about whom they are notified pursuant 
to Paragraph (a) comply with control measures 
given by the local health director to prevent 
transmission in the facility or establishment: 



(1) 

(2) 
(3) 



(4) 



the principal of any private or public 
school; 
employers; 

superintendents or directors of aU public 
or private institutions, hospitals, or jails; 
and 

operators of a child day care center, child 
day care home, or other child care pro- 



viders. 



Statutory Authority G.S. I30A-I43; I30A-144. 
CHAPTER 8 - HE.\LTH: PERSONAL HEALTH 

SLBCHAPTER 8D - CHILDREN'S SPECIAL 

HEALTH SERVICES: DEVELOPMENTAL 

DISABILITIES BRANCH 

SECTION .0700 - ROSTERS 

.0701 QLALIFICATIONS 

(a) The physician applicant for full rostcring 
status must be a resident of North Carolina, li- 
censed to practice medicine in the state, ha\e 



S80 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



hospital privilcucs in the community of his/her 
practice, be board-certified in a speciahy with 
pediatric training in that speciahy, and meet the 
criteria of the American Academy of Pediatrics 
for that speciahy. ttf»4 board cortifiod i» » spe- 
cialty rooognii'.od by the ii\morican Modiool As- 
Dociation. 

(b) Proviuional rootoring »»y b» oonoidorod fof 
» phyoician wbe praotiooG m 9» afea >s'horQ thoro 
are »» physicians rost e r g d *» his/h e r sp e cialty, if 
he/sho has ff«*t- ali formal academic training 6»- 
toria roquirod by » opocialty board rocognieod by 
the lAmoricon Modical Aosociation. Provisional 
rootoring shall be valid until a opocialist » y*« 
afea bocomoo rostered i» tba* specialty. There 
shall be two categories of rostcred physicians 
under Children's Special Health Services: 

( 1) A fuUy rostered physician will have met 
all the requirements set forth in Paragraph 
(a) of this Rule. Physicians rostered by 
the program prior to the date of imple- 
mentation of this Rule shall be considered 
fully rostered; 

(2) A physician may be conditionaUv rostered 
if there is no fully rostcred physician in the 
same geographic region. A conditionally 
rostered physician must meet all of the 
requirements set forth in Paragraph (a) for 
a fully rostcred physician, except for the 
requirements that a physician be board- 
certilied or meet the criteria of the Amer- 
ican Academy of Pediatrics for that 
specialty. 1 lowever, the physician must 
possess pediatric experience in a specialty 
and provide services necessary' for the care 
of children in that geographic region. The 
status of the conditionally rostered physi- 
cian shall be reviewed every three years. 

Children's 



S£e 



Health Services shall have 



written policies go\eming the rostenng process. 
Statutory Authority G.S. I30A-I24. 

.0707 AD.MIMSTKATIVE REQUIREMENTS 

The applicant for rostering agrees; 

(1) To encourage insurance clerk/office man- 
ager to be properly trained regarding Chil- 
dren's Special I lealth Services and its forms; 

(2) To properly prepare or ensure the com- 
pletion of forms and paperwork as indicated 
or needed for services to the family; 

(3) To take responsibility for prep;iring requests 
for ancillary' services such as drugs and sup- 
plies; and 

(4) Not to hold the patient or family responsi- 
ble for unprocessed or unpaid bills for phy- 
sician's services which are due to provider 



error or non-compliance with program 
guidelines. 

Statutory Authority G.S. I30A-I24. 

SUBCHAPTER 8G - PERINATAL CARE 

SECTION .0900 - CONTRACTS FOR 
EDUCATION AND TRAINING 

.0904 ANNUAL REPORT 

(a) The contractor shall submit an annual re- 
port to the perinatal program and the regional 
committee within 60 45 days from the close of 
the contract period. Contents of the report shall 
meet program guidance with regards to partic- 
ipation and evaluation of educational offerings. 
^n^ r e port shall includo a» e^'aluation addrosC f ing 
pro gross m mooting the oduoational objoctivoo 
outlinod m the appUcation. It- shall alse includo 
a list- »f porsons participating i» the educational 
activities supported tlirough the contract (ifi- 
oluding namo, title, county afi4 place ef work). 

Statutory Authority G.S. I30A-I27. 

CHAPTER 10 - HEALTH SERVICES: 
ENVIRONMENTAL HEALTH 

SUBCHAPTER lOA - SANITATION 

SECTION .2100 - RULES GOVERNING THE 

SANITATION AND SAFETY OF MIGRANT 

HOUSING 

.2119 GRADING 

(b) The migrant housing shall be classified as 
follows: 

(3) As disapproved, if conditions resulting if* 
a provisional classification have set- boon 
corr e cted within upon reinspection after 
expiration of the specified time period, the 
demerit score is greater than 20 or any 
six-demerit point item is found to be vio- 
lated. 

Statutory Authority G.S. I30A-239. 

.2122 BUILDINGS 

(g) Each room, except toilet rooms and rooms 
with no exterior walls, in a migrant housing 
buUdmg shall be provided with screened windows 
the total area of which shall be not less than 
one-tenth of the floor area of each room, ex- 
cluding closet space. A window shall be an 
opening to the outside that can be closed to 
protect against the elements. Doors that are 
provided with screens and that can be closed to 
protect against the elements shaU be considered 
equivalent to screened windows in determining 



NORTH CAROLINA REGISTER 



881 



PROPOSED RULES 



the total area of screened windows in a migrant 
housing building. At least one-half of each win- 
dow shall be so constructed that it can be opened 
for purposes of ventilation. A toilet room shall 
be provided with a screened wLndow(s) not less 
than six square feet in area or shall be provided 
with mechanical ventilation. 

Statutory' Authority G.S. 130A-239. 

.2123 WATER SUPPLY 

(d) A functional hot water system shall be 
provided for laundrv', bathing, and food prepara- 
tion purposes. The hot water system shall be 
sized to provide a storage capacity plus a recov- 
ery to 140 degrees Fahrenheit per hour capacity 
equal to a total of five gallons per person. Unless 
otherwise stated on the water heating equipment, 
recover,' shall be based on 4. 1 gallons per hour 
per kilowatt (KW) or, one gallon per hour per 
834 British thermal units (BTU). 

Statutory Authority G.S. 130A-239. 

.2129 KITCHEN AND DINING FACILITIES 

(b) A kitchen facilitioc . s4«iH t>e providod facility 
with an operable stove, fs) refrigerator, fs^ table 
{%) and sink {^ shall be pro\idcd. 

(c) All food service facilities, other than those 
where migrants procure and prepare food for 
their own consumpticm, shall comply with the 
following: 

(4) Food Service Persons 

Ht & communioubl e fonn. »f while a eaf- 
Ht» ef L i uch <* du . L'uo i j, Bf ' ■ ' ■ hilo atflictc'd 
with boils, infuctL'd ' ■ sounds, sores, »f aft 
acut e respiratoP i ' infection, ahull work i» 
afty capacity i» vrhich th e re is a lilielihood 
ef t4w4- person's contaminating food ef 
food contact ourf t xcen with pathogenic 
organisms, tf eitlier A*» migrant housing 
operator ef crevs' leader has reason k* «*s- 
p e ct t4w4- aftv food sers'lc e person has 
contracted aft¥ disease ift a communicable 
fonn Bf has becom e a carri e r ©f ouch d*s- 

■ ^ ' 1 .- ,"k 1-1 .1 ■ t-v • 1 1 1 j-1 . t f ■ T 1 ; * l-» 1 » 1 ft .-• -^ 1 1-1 i-t ■ t 1 1 t-i . « . t 

CTTT^ty 1 iV TTTTTIT I II > l Li T 1 1 1\.' IV.' VLTT rTCTTTTTT U^' 

purtment immediately. 
Statuto/y Authority OS. 1 30 A- 239. 
SUBCHAPTER lOB - SHELLFISH SANITATION 

SECTION .1400 - CL.\SSIFICATION OF 
SHELLFISH GRO\MNG W.ATERS 

.1401 DEFINITIONS 

The following definitions shall apply through- 
out this Section. 



(1) "Approved area" means an area deter- 
mined suit.ible for the harvest of shellfish for 
direct market purposes. 

(2) "Closed - system marina" means a marina 
constructed in canals, small basins, small 
tributaries or any other area with restricted 
tidal flow. 

(3) "Commercial marina" means marinas that 
offer one or more of the following services: 
fuel, haul-out facilities, or repair services. 

(4) "Conditionally approved area" means an 
area subject to predictable intermittent pol- 
lution that may be used for harvesting 
shelllish for direct market purposes when 
management plan criteria are met. 

(5) "Depuration" means mechanical purifica- 
tion or the removal of adulteration from live 
shellstock by any artificially controlled 
method. 

(6) "Division" means the Division of Health 
Services or its authorized agent. 

(7) "Fecal coliform" means bacteria of the 
coliform group which will produce gas from 
lactose in a suitable muhiple tube procedure 
liquid medium (EC or A-1) within 24 plus 
or minus two hours at 44.5°C plus or minus 
0.2'C in a water bath. 

(8) "Growing waters" means waters which 
support or could support shellfish life. 

(9) "Marina" means any water area with a 
structure (dock, basin, floating dock, etc.) 
which is utilized for docking or otherwise 
mooring vessels and constructed to provide 
temporary or permanent docking space for 
more than ten boats. 

(10) "Marine biotoxins" means a poisonous 
substance accumulated by shellfish feeding 
upon dinoflagellates containing toxins. 

(11) "Most probable number (MPN)" means 
a statistical estimate of the number of bac- 
teria per unit volume and is determined from 
the number of positive results in a series of 
fermentation tubes. 

(12) "Open - system marina" means a marina 
constructed in an area where tidal currents 
have not been impeded by natural or man- 
made barriers. 

(13) "Private marina" means marinas private 
or residential that are not commercial 
marinas. 

(14) "Prohibited area" means an area unsuit- 
able for the harvesting of shellfish for direct 
market purposes. 

(15) "Public health emergency" means any 
condition that may immediately cause 
shelllish waters to be unsafe for the han'est 
of shellfish for human consumption. 



SS2 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(16) "Relaying" means the act of removing 
shellfish from one growing area or shellfish 
grounds to another area or ground for any 
purpose. 

(17) "Restricted area" means an area from 
which shellfish may be harvested only by 
permit and subjected to an approved 
depuration process or relayed to an ap- 
proved area. 

(18) "Sanitary sur\'ey" means the evaluation 
of factors that affect the sanitary quality of 
a shellfish growing area including sources of 
pollution, the effects of wind, tides and cur- 
rents in the distribution and dilution of pol- 
luting materials, and the bacteriological 
quality of water. 

(19) "Shellfish" means oysters, mussels, and all 
varieties of clams. 

(20) "Shoreline survey" means a visual in- 
spection of the envLTonmental factors that 
affect the sanitary quality of a growing a"-"-! 
and identifies sources of pollution when 
possible. 

Statutory Authority G.S. / 30 A -230. 

.1402 CLASSIFIC.VTION OF SHELLFISH 
GRO\M\G W ATKRS 

(a) All actual and potential shellfish growing 
areas shall be classified as to their suitability for 
shellfish harvesting. Growing waters shall be 
designated with one of the following classifica- 
tions: 

(1) Approved area, 

(2) Conditionally approved area, 

(3) Restricted area, or 

(4) Prohibited area. 

(b) Maps showing the boundaries and classi- 
fication of growing areas shall be maintained by 
the division. 

Statutory^ Authority G.S. I30A-230. 

.1403 S.\MT.\RY SLRVEY 

(a) Growing waters shall be divided into grow- 
ing areas by the division. 

(b) A sanitary sur\'ey shall be conducted for 
each growing area every three years except grow- 
ing areas that are totally prohibited, and shall in- 
clude the following: 

(1) A shoreline suHr'cy to evaluate poUution 
sources that may aJfcct the area. 

(2) A hydrographic sur\'ey to evaluate 
meteorological and hydrographic factors 
that may affect distribution of pollutants. 

(3) A bacteriological survey to assess water 
quality. A bacteriological survey shall in- 
clude the collection of growing area water 



samples and their analysis for fecal 
coliforms. The number and location of 
sampling stations shall be selected to 
produce the data necessary to effectively 
evaluate point and non-point pollution 
sources. A minimum of 15 sets of sam- 
ples shall be collected from growing areas 
during the three year evaluation period. 
Areas without a shoreline may be sampled 
less frequently. 

(c) Sanitary survey reports shall be prepared for 
each growing area every three years. 

(d) All sanitary survey reports shall be main- 
tained by the division. 

Statutory Authority G.S. I30A-230. 

.1404 APPROVED AREAS 

An area classified as approved for shellfish har- 
vesting for direct market purposes, must satisfy 
tb( following criteria as indicated by a sanitary 
sur\-ey: 

(1) the shoreline sur%ey has indicated that there 
is no significant point source contamination; 

(2) the area is not contaminated with fecal 
material, pathogenic microorganisms, poi- 
sonous and deleterious substances, or ma- 
rine biotoxins that consumption of the 
shellfish might be hazardous; 

(3) the median fecal cohform Most Probable 
Number (MPN) or the geometric mean 
MPN of water shall not exceed 14 per 100 
milliliters, and not more than ten percent of 
the samples shaU exceed a fecal coliform 
MPN of 43 per 100 milliliters (per five tube 
decimal dilution) in those portions of areas 
most probably exposed to fecal contam- 
ination during most unfavorable 
hydrographic conditions. 

Statutory Authority G.S. I30A-230. 

.1405 CONDITIONALLY APPROVED AREAS 

(a) An area may be classified as conditionally 
approved if the sanitary survey indicates the area 
will meet approved area classification criteria for 
a reasonable period of time and the factors de- 
termining these periods are known and predict- 
able. 

(b) A written management plan shall be devel- 
oped by the division for conditionally approved 
areas. 

(c) When management plan criteria are met the 
division may recommend to the Division of Ma- 
rine Fisheries the area may be opened to shcUfish 
han'csting on a temporary basis. 

(d) When management plan criteria are no 
longer met or public health appears to be jeop- 



NORTH CAROLINA REGISTER 



883 



PROPOSED RULES 



ardized, the division will recommend to the Di- 
vision of Marine Fisheries immediate closure of 
the area to shellfish han'csting. 

Statutory Authority G.S. I30A-230. 

.1406 RESTRICTED AREAS 

(a) /\n area may be classified as restricted when 
a sanitary survey indicates a limited degree of 
pollution and the area is not contaminated to the 
extent that indicates that consumption of 
shellfish could be hazardous after controlled 
depuration or relaying. 

(b) Relaying of shellfish shall be conducted in 
accordance with 10 NCAC lOB, Rules Govern- 
ing the Sanitation of Shellfish. 

(c) Depuration of shellfish shall be conducted 
in accordance with 10 NCAC lOB, Rules Gov- 
erning the Sanitation of Shellfish. 

Statutory Authority G.S. J30A-230. 

.1407 PROHIBITED AREAS 

A growing area shall be classified prohibited if 
there is no current sanitary survey or if the sani- 
tary survey or other monitoring program data 
indicate that the area does not meet the criteria 
as specified in approved, conditionally approved 
or restricted classifications. llie taking of 
shellfish for any human food purposes from such 
areas shall be prohibited. 

Statutory Authority G.S. J30A-230. 

.1408 LNSLRVEVED AREAS 

Growing areas which have not been subjected 
to a sanitary survey shall be classified as prohib- 
ited. 

Statutory Authority G.S. I30A-230. 

.1409 Bl KKER ZONE 

A prohibited area shall be established as a buffer 
zone around each wastewater treatment plant 
outfall. 

Statutory Authority G.S. I30A-230. 

.1410 RECLASSIFICATION 

(a) .Any upward revision of an area classifica- 
tion shall be supported by a sanitary sur\'ey and 
documented in the sanitary survey report. 

(b) A downward revision of an area classifica- 
tion may be made without a sanitary survey. 

(c) WTicn growing waters are reclassified, ap- 
propriate recommendation shall be made to the 
Division of Marine Fisheries regarding the open- 



ing and closure of the waters for the harvest of 
shellfish for human consumption. 

Statutory Authority G.S. 130A-230. 

.1411 MARINAS: DOCKING FACILITIES: 
OTHER MOORING AREAS 

Classification of shellfish growing waters with 
respect to marinas, docking facilities, and other 
mooring areas shall be done in accordance with 
the following; 

( 1 ) AH waters within the immediate vicinity of 
a marina shall be classified as prohibited to 
the harvesting of shellfish for human con- 
sumption. Excluded from this classification 
are boat ramp facilities and all other docking 
areas with less than 30 slips, having no boats 
over 21 feet in length and no boats with 
heads (bathroom facilities). 

(2) Additional waters beyond the marina may 
be classified as prohibited to shellfish har- 
vesting. The minimum requirement for the 
additional prohibited area adjacent to the 
marina shall be based on the number of slips 
and the type of marina (open or closed sys- 
tem). The automatic prohibited area shall 
extend beyond the marina from all boat 
slips, docks, and docking facilities, according 
to the following: 



Number of Slips 


Size of Prohibited 


in Marina 


Area (Feet) 




Open 


Closed 




System 


System 


11 - 25 


100 


200 


26 - 50 


150 


275 


51 - 75 


175 


325 


76 - 100 


200 


400 



(3) 



Open system marinas exceeding 100 slips 
shall require an additional 25 feet for each 
25 sUps or portion thereof over 100. A 
closed system marina shall require 50 feet 
for each 25 slips or portion thereof over 
100. Closed system private or residential 
marinas with more than 75 slips shall re- 
quire a prohibited area of the number of 
feet determined above, or 100 feet outside 
the entrance canal, whichever is greater. 
Closed system commercial marinas with 
more than 50 slips shall require a prohib- 
ited area of the number of feet determined 
above, or 100 feet outside the entrance 
canal, whichever is greater. 
After the marina is put in use water quality 
impacts of marina facilities may require a 
change in classification. In determining if 



SS4 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



a change in classification is necessary, 
marina design, marina usage, dilution, 
dispersion, bacteriological, hydrographic, 
meteorological, and chemical factors will 
be considered. 

(4) Areas, other than marinas, where boats are 
moored or docked shall be considered on 
a case-by-case basis with respect to sani- 
tary' significance relative to actual or po- 
tential contamination and classification 
shall be made as necessary. 

(5) The cumulative impacts of multiple 
marinas, entrance canals, or other 
mooring areas, in close proximity to each 
other are expected to adversely affect 
public trust waters. When these situations 
occur the division wlU recommend clo- 
sures exceeding those outlined in Para- 
graph (2) of this Rule. The foUowLng 
guides will be used in determining close 
proximity: 

(a) marina entrance canals within 225 feet 
of each other; 

(b) open system marinas within 450 feet of 
each other (Mooring areas shall be con- 
sidered open system marinas); 

(c) where closure areas meet or overlap; and 

(d) open system marinas witliin 300 feet of 
a marina entrance canal. 

Statutory Authority G.S. /30A-230. 

.1412 SHELLFISH MANAGEMENT ARE.\S 

When the Division of Marine Fisheries begins 
operations to relocate shellfish from a restricted 
or conditionally approved area to an approved 
area, the division wiU recommend to the Division 
of Marine Fisheries that the area of relocation 
be closed until cleansing requirements for relayed 
shellfish have been satisfied. 

Statutory Authority G.S. /30A-230. 

.1413 PLBLIC HEALTH EMERGENCY 

(a) The division shall recommend to the Divi- 
sion of .Marine Fisheries immediate closure of 
shellfish waters to the harvesting of shellfish due 
to a public health emergency. 

(b) The division shall recommend to the Divi- 
sion of Marine Fisheries re-opening shellfish wa- 
ters when the condition causing the public health 
emergency no longer exists and shellfish have had 
sufficient time to purify naturally from possible 
contamination. 

Statutory Authority G.S. I30A-230. 

.1414 LABORATORY PROCEDL'RES 



All laboratory examinations for water and 
shellfish used for the evaluation of growing areas 
shall be made in accordance with the latest ap- 
proved edition by the Food and Drug Adminis- 
tration of "Recommended Procedures for 
Bacterial Examination of Sea Water and 
Shellfish", American Public Health Association, 
Inc. A copy of this publication is available for 
inspection at the Shellfish Sanitation Office, Ma- 
rine Fisheries Building, Arendell Street, 
Morehead City, North Carolina 28557. 

Statutory Authority G.S. I30A-230. 

SUBCHAPTER IOC - VECTOR CONTROL 

SECTION .0300 - SANITATION OF BEDDING 

.0314 AUTHORIZED SANITIZING 
PROCESSES 

(c) The Steri-Fab spray sterilization system 
may be used for sanitization if applied in ac- 
cordance with the manufacturer's directions. 

Statutory Authority G.S. I30A-273. 

SUBCHAPTER I OF - HAZARDOUS WASTE 
MANAGEMENT 

.0001 GENERAL 

(b) The solid aft4 hazardous waste branch of 
the Division of Health Services shall administer 
the hazardous waste management program for 
the State of North Carolina. 

(d) Copies of aU material adopted by reference 
in this Subchapter may be inspected in the Solid 
aft4 Hazardous Wasto branch office, Divioion ef 
Health SomcoD, ^06 Nr Wilmington Stroot, 401 
Oberlrn Road, P.O. Box 2091, Raleigh, N.C. 
27602. Copies may be obtained from the Solid 
afi4 Hazardous Waoto branch at the actual cost 
to the branch. 

Statutory Authority G.S. 130A-294(c). 

.0002 DEFINITIONS 

(b) This Rule shall apply throughout this 
Subchapter except that: 

(4) Branch shall be the Hazardous Waste 
Branch in the Solid Waste Management 
Section. 

Statutory Authority G.S. l30A-294(c). 

.0032 STANDARDS FOR OWNERS/ 
OPERATORS OF IIWMF'S - 
PART 264 

(i) "Financial Requirements" contained in 40 
CFR 264.140 to 264.151 (Subpart H) have been 



NORTH CAROLINA REGISTER 



885 



PROPOSED RULES 



adopted by reference in accordance with G.S. 
1 SOB- 14(c), except that 40 CFR 264.143(a)(3), 
(a)(4), (a)(5), (a)(6), 40 CFR 264.145(a)(3), 
(a)(4), (a)(5), (a)(6), and 40 Gt* 261.M7(a), 40 
GPJ^ 261.1 17(b), 40 CFR 264.151(a)(1), Section 
15 aR4 40 Gt* 26'1.151(g), ttft4 40 GPR 
261.151(q), (b).(c),(d).(a).(f),(h),(i), aft4 (j^ are 
not adopted by reference. 

Statutory Authority G.S. l30A-294(c). 

.0033 INTERIM STATUS STANDARDS FOR 
HWMF'S -PART 265 

(h) "Financial Requirements" contained in 40 
CFR 265.140 to 265.151 (Subpart H) have been 
adopted by reference in accordance with G.S. 
150B- 14(c), except that 40 CFR 265.143(a)(3), 
(a)(4), (a)(5), (a)(6), 40 Gf* 265.M7(a), »ft4 40 
CFR 265.1 ' 17(b), are not adopted by reference. 

Statutory Authority G.S. l30A-294(c). 

.0042 LAND DISPOSAL RESTRICTIONS - 
PART 268 - SLBPART A - GENERAL 

(a) The "General" provisions contained in 40 
CFR 268.1 to 34^« 268.13 (Subpart A) have 
been adopted bv reference in accordance with 
G.S. 15UB- 14(c). 

(b) The "Prohibitions on Land Disposal" pro- 
visions contamed in 40 CFR 268.30 to 268.32 
268.33 (Subpart C) have been adopted by refer- 
ence in accordance with G.S. 150B- 14(c). 

Statutory Authority G.S. l30A-294(c). 

SUBCHAPTER lOH - INACTIVE HAZARDOUS 
SUBSTANCES AND WASTE DISPOSAL SITES 

SECTION .0200 - PRIORITIJt-ATION SYSTEM 

.0201 PRIORITIZATION 

(a) The division shall review and evaluate rele- 
vant site data for all inactive hazardous substance 
or waste disposal sites and prioritize those sites 
using the priority system established in this Sec- 
tion. 

(b) Only sites with confirmed contamination 
shall be placed on the inacti\e hazardous waste 
sites priority list. Contamination is confirmed if 
laboratory analyses show the presence of haz- 
ardous substances in groundwater, surface water, 
air, wastes, or soils at concentrations significantly 
above background levels. Concentrations are 
significantly above background if the levels de- 
tected are more than: 

(1) ten times a detected level in the back- 
eround, or 



(2) three times the detection limit when the 
background level is below the detection 
limit. 

(c) A site shall be prioritized based on condi- 
tions present at the time of evaluation. All prior 
removal actions shall be considered. 

(d) A site shall be evaluated and receive a sep- 
arate score in each of the following categories: 

(1) groundwater migration, 

(2) surface water migration, 

(3) air migration, and 

(4) direct contact. 

(e) A total score for the site shall be determined 
by taking the square root of the sum of the 
squares of the scores in the four categories in 
Paragraph (d) and dividing by two. 
Prioritization shall be based upon the total score. 

Statutory Authority G.S. 130A-3I0.I2. 

.0202 GROUNDWATER MIGRATION 

(a) The potential for groundwater contam- 
ination is based upon route characteristics, waste 
containment, and waste characteristics. The 
score for groundwater migration shall be deter- 
mined by multiplying the score determined for 
route characteristics in Paragraph (b) by the score 
determined for waste containment in Paragraph 

(c) then multiplying that result by the score de- 
termined for waste characteristics in Paragraph 

(d) and dividing that result by 13.26. 

(b) .A score for route charactenstics shall be 
determined by adding the values assigned in 
Subparagraphs (b)(1) through (b)(4). 

(1) A value shall be assigned for depth to 
water table using either Table 1 if depth 
to water table is known or Table 2 if 
depth to water table is unknown. Depth 
to water table is measured vertically from 
the lowest point of the hazardous sub- 
stances to the highest seasonal level of the 
water table. 

Table 1 



Depth 


Assigned Value 


> 150 feet 

> 75 to 150 feet 

> 20 to 75 feet 
_<_ 20 feet 

Contaminant in groundwater 



2 
4 

6 

8 



Table 2 

Location Assigned Value 

Piedmont and Mountain 4 



SS6 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Coastal Plain 
Alluvial Valley 



4 
6 



(2) 



A value shall be assigned for net precipi- 
tation using Table 3. Net precipitation 
shall be calculated by subtracting iLc 
mean annual lake evaporation from the 
mean annual precipitation. 



Table 3 



Net Precipitation 

_^ -10 inches 

> -10 to -(-5 inches 

> + 5 to + 1 5 inches 

> +15 inches 



Assigned Value 


1 
2 
3 



(3) A value shall be assigned for hydraulic 
conductivity using Table 4 when data fr>r 
hydraulic conductivity are available, using 
the table entitled "Permeability of 
Geologic Materials" that is contained in 
40 CFR 300, Appendix A jwhich is 
hereby adopted by reference in accordance 
with G.S. I50B-14(c)j when hydraulic 
conductivity data are unavailable but soil 
and rock types are known, and using Ta- 
ble 5 when hydraulic conductivity data are 
unavailable and soil and rock types are 
unknown. 

Table 4 



Approximate Range 
of I lydraulic 
Conductivity 

< 10"' cm/sec 

> 10' to 10-' cm/sec 

> 10^ to 10^ cm/sec 

> 10^ cm/sec 



Table 5 



Assigned Value 


1 
2 
3 



physical state, the hazardous substance or 
waste with the highest value shall be used. 

Table 6 



Physical State 


Assigned Value 


Solid, consolidated 





and stabilized 




Solid, unconsolidated 


1 


or unstabilized 




Solid, powder or fme 


2 


particles 




Liquid, sludge or gas 


3 



(c) A score for containment shall be determined 
by using the table entitled "Containment Value 
for Ground Water Route," contained in 40 CFR 
300, Appendix A [which is hereby adopted by 
reference in accordance with G.S. 150B-14(c)|. 
It the site has more than one type of contain- 
ment, the contairmient with the highest value 
shall be used. 

(d) A score for waste characteristics shall be 
determined by adding the values assigned in 
Subparagraphs (d)(1) and (d)(2). In determining 
a waste characteristics score, the substance with 
the highest combined toxicity/persistence and 
waste quantity values shall be used. 

(1) A value for toxicity and persistence shall 
be assigned using the section entitled 
"Toxicity and Persistence" contained in 
40 CFR 300, Appendix A [which is 
hereby adopted by reference in accordance 
with G.S. 150B-14(c)l. 

(2) A value for hazardous waste quantity shall 
be assigned using Table 7 when waste 
quantity is known, and by assigning a 
value of five when waste quantity is un- 
known. Hazardous waste quantity is de- 
fmed as the amount deposited, not how 
much would have to be removed to clean 
up the site. When necessary to convert 
data to a common unit, conversion shall 
be as follows: one drum equals seven 
cubic feet equals 50 gallons equals 500 



Location Assigned Value 


pounds. 




Triassic basin 1 


Table 7 




Piedmont and Mountain 2 






Mountain /Mluvial Valley 3 


Waste Quantity 


Assigned Value 


or Coastal Plain 








None 





(4) A value shall be assigned for physical state 


De minimus losses only 


1 


using Table 6. Physical state is the state 


< 10 pounds 


2 


of hazardous substances at the time of 


> 10 pounds to 100 


3 


disposal. If the site contains hazardous 


pounds 




substances or wastes with more than one 


> 100 pounds to 1000 


4 



NORTH CAROLINA REGISTER 



887 



PROPOSED RULES 



pounds 

> 1000 pounds 5 
_<_ 10 gallons 3 

> 10 gallons to 100 4 
gallons 

> 100 gallons to 1000 5 
gallons 

> 1000 gallons 6 
_<_ 10 cubic feet 4 

> 10 cubic feet to 100 5 
cubic feet 

> 100 cubic feet to 1000 6 
cubic feet 

> 1000 cubic feet 7 
_<_ 10 drums 5 

> 10 drums to 100 6 
drums 

> 100 drums to 1000 7 
drums 

> 1000 drums 8 

Statutory Authority G.S. 130A-310.I2. 

.0203 SURFACE WATER MIGRATION 

(a) The potential for surface water contam- 
ination is based upon route characteristics, waste 
containment, and waste characteristics. The 
score for surface water migration is determined 
by multiplying the score determined for route 
characteristics in Paragraph (b) by the score de- 
termined for waste containment in Paragraph (c) 
then multiplying that result by the score deter- 
mined for waste characteristics in Paragraph (d) 
and dividing that result by 13.26. 

(b) A score for route characteristics shall be 
determined by adding the values in Subpara- 
graphs (b)(r) througli (b)(4). 

(1) A value shall be assigned for facility slope 
and intervening terrain using the table en- 
titled "Values for Facility Slope and In- 
tervening Terrain," that is contained in 40 
CFR 300, Appendix A [which is hereby 
adopted by reference in accordance with 
G.S. 150B-14(c)l. 

(2) A value shall be assigned for one-year 
24-hour rainfall using Table 8. The 
amount of rainfall shall be determined 
using Figure 1, entitled "24-hour 
ramfall", m 40 CFR 300, Appendix A, 
which is hereby adopted by reference in 
accordance with G.S. 1 SOB- 14(c). 

Table 8 



One-"\'car 24-hour 
Rainfall Amount 

(inches) 



_<_2.5 

> 2.5 to 3.0 

> 3.0 to 3.5 

> 3.5 



(3) 



A value shall be assigned for distance to 
nearest surface water using Table 9. Dis- 
tance to the nearest surface water shall be 
determined by measuring the shortest dis- 
tance from the hazardous substance (not 
the facihty or property boundary) to the 
nearest downhill body of surface water 
that is on the course that run-off can be 
expected to follow. 

Table 9 



Distance 


Assigned Value 


> 2 miles 





> 1 to 2 miles 


2 


> 1000 feet to 1 mile 


4 


> 200 feet to 1000 feet 


6 


< 200 feet or 


8 


contammant m 




surface water or 




sediment 





Assigned Value 



(4) A value for physical state shall be assigned 
as determined in Rule .0202(b)(4) of this 
Section. 

(c) A score for containment shall be determined 
by using the table entitled "Containment Values 
for Surface Water Route," contained in 40 CFR 
300, Appendix A (which is hereby adopted by 
reference in accordance with G.S. 150B- 14(c)]. 
If the site has more than one type of contain- 
ment, the containment with the highest value 
shall be used. 

(d) A score for waste characteristics shall be 
assigned as determined in Rule .0202(d) of this 
Section. 

Statutory Authority G.S. I30A-310.I2. 

.0204 AIR MIGRATION 

A score for air migration shall be determined 
by using Section 5.0 entitled "Aix Route" con- 
tained in 40 CFR 300, Appendix A [which is 
hereby adopted by reference in accordance with 
G.S. 150B- 14(c)]. However, Section 5.1 entitled 
"Observed Release" contained in 40 CFR 300, 
Appendix A, is not adopted by reference. A 
score for air migration shall be determined by 
multiplying the score determined for waste char- 
acteristics in Section 5.2 of 40 CFR 300, Appen- 
dix A, by the score determined for targets in 



SS8 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Section 5.3 of 40 CFR 300, 
dividing that result by 7.8. 



Appendix A, and 



Statutory Authority G.S. I30A-3I0.I2. 

.0205 DIRKCT CONTACT 

(a) A direct contact score shall be determined 
by adding the score for residential population 
determined in Paragraph (b), and the score for 
nearby population determined in Paragraph (c), 
and di\iding the result by 18. 

(b) A score for residential population shall be 
determined by multiplying the value for toxicity 
assigned in Subparagraph (b)(1) by the value for 
targets assigned in Subparagraph (b)(2). 

(1) A value for toxicity shall be assigned bv 
multiplying by three the value for toxicuy 
as assigned in Rule .0202(d)(1) of this 
Section. 
- (2) A value for residential targets shall be as- 
signed by adding the value for high risk 
population assigned in Subparagi. 
(b)(2)(A) and the value for total resident 
population assigned in Subparagraph 
(b)(2)(B) and the value for sensitive envi- 
ronment assigned in Subparagraph 
(b)(2)(C). In order to evaluate residential 
targets, there must be confirmed contam- 
ination within the property boundaries of 
a residence or school day-care center, or 
within the boundaries of a sensitive envi- 
ronment. 

(A) A value for high risk population shall 
be assigned by multiplying the resident 
children, age six and under, by eight, with 
a maximum value of 100. 

(B) A value for total resident population 
shall be assigned by multiplying the total 
resident population by two, with a maxi- 
mum value of 100. 

(C) A value for sensitive enviromnents shall 



species 
National preserve 20 

National or State 20 

wildlife refuge 
Federal land designated 20 

for protection of 

natural ecosystems 
Administration proposed 20 

federal wilderness area 
Habitat known to be used 15 

by State-designated 

endangered or threatened 

species 
Habitat known to be 15 

used by species under 

review as to its 

federally designated 

threatened and 

endangered status 
State lands designated 10 

for wildlir or game 

managemjnt 

(c) A score for nearby population shall be de- 
termined by multiplying the value for likeHhood 
of exposure assigned in Subparagraph (c)(1) by 
the value for toxicity assigned in Subparagraph 
(c)(2) and multiplying that result by the value for 
nearby targets assigned in Subparagraph (c)(3). 
The nearby population consists of individuals 
who live or go to school within one mile of an 
area containing contaminated sods or wastes. 
(1) A value for likelihood of exposure shall 
be assigned by using the area of contam- 
ination value assigned in Table 1 1 and the 
accessibility frequency of use value as- 
signed in Table 12 to arrive at the value 
assigned in Table 13. 

Table 11 



be assigned using T 


able 


10. 


Total Area of 
Contamination 


Assigned Value 


Table 


10 




No contamination 





Sensitive En\ironmcnt 




Assigned Value 


< 1 acre 

> 1 acre to 5 acres 


25 
50 


Critical habitat for 




25 


> 5 acres to 10 acres 


75 


federally designated 






> 10 acres 


100 


endangered or 










threatened species 






Table 12 




National park 




25 






Designated federal 




20 


Accessibility/Frequency 


Assigned Value 


wilderness area 






of Use 




habitat known to be 










used by federally 






Obser\'ed contamination on 


100 


designated (or proposed) 




residential property or 




threatened or endang 


;red 




on property of a park, 





NORTH CAROLINA REGISTER 



889 



PROPOSED RULES 



playground, school, or 

other area designated 

for use by the public. 
Observed contamination 75 

on land with no 

continuous barrier to 

entry, a bamer that 

has been breached: or 

land where there are 

clear indications of 

human activity (i.e., 

footprints). 
Obsen.ed contamination 50 

on land either protected 

by a continuous and 

effective barriers to 

entry, or monitored by 

24-hour surveillance. 
Observed contamination 25 

on land protected by a 

continuous and effective 

barrier to entry and 

24-hour sur%eiLlance. 
Presence of an 5 

artiticial bamer and a 

natural barrier that 

combine to restrict 

access to hazardous 

substances by completely 

surrounding the facility; 

and a means to control 

entry, at all times, 

through gates or other 

entrances to the 

facility. 

(2) A value for toxicity shall be assigned by 
multiplying by three the value for toxicity 
as assigned in Rule .0202(d)(1) of this 
Section. 

(3) A value for nearby targets shall be assigned 
by multiplymg the population withm ' : 
mile of the site by 0.1, and adding the re- 
sult of multiplying 0.05 by the population 
between '2 and 1 mile of the site, with a 
maximum total value of 100. 







Table 


13 






.Area of 












Contain 




Accessibilitv Frequencv 




mation 




of Use Val 


ue 




Value 


100 


75 


50 


25 


5 


100 


1 


1 


0.75 


0.5 


0.25 


75 


1 


0.75 


0.5 


0.25 


0.1 


50 


0.75 


0.5 


0.25 


0.1 





25 


0.5 


0.25 


0.1 









No Con- 

firmed 
Contam- 
ination 

Statutory Authority G.S. I30A-310.I2. 



Jyotice is hereby gi\'en in accordance with G.S. 
I SOB- 1 2 that the Commission for Mental Health, 
Mental Retardation and Substance Abuse Services 
intends to adopt, amend, repeal rulefsj cited as 
JO \CAC 1 40 .0101 - .0102, .0201 - .02/2. .0301 
■ .0306; I4H .0101 - .0104, .0201 - .0208, .0301 - 
.0302. .0401 - .0403: 141 .0101 - .0106, .0201 - 
.0204. .0301 - .0308. .0310; 14J .0101 - .0107, 
.0201 - .0209, .0301 - .0302, .0401 - .0404; 14K 
.0219; ISA .0204 - .0228; 181 .01 IS; 18J .0709, 
.0712; I8L .03.^^3 - .0334, .0338, .0429, .0432. 
.0604. .0^02 - .0703, .070S - .0707, .0804 - .0809, 
.0903 - .0904, .1002, .1004 - .1006, .1102 - .1107, 
.1203 - .1206, .1302 - .130S, .1402 - .1403; 18Q 
.0284. .0286, .0S21. .0709 - .071S, .0803 - .0804. 
.0808, .0810, .08/2; 18R .0205; 4SG .0110. 

1 he proposed effective date of this action is Ma\ 
1, 1989. 

1 he public hearing will be conducted at 10:00 
a.m. on February IS, 1989 at Holiday Inn State 
Capitol, 320 Hillsborough Street, Raleigh, 
27603. 



\C 



c 



-omment Procedures: Any interested person 
may present his her comments by oral presentation 
or by submitting a written statement. Persons 
wishing to make oral presentations should contact 
Jackie Ransdell, Dtiision of .Mental Health, Men- 
tal Retardation and Substance Abuse Services, 
32S X. Salisbury Street, Raleigh. \C 27611, 
(919) 733-7971 by February IS, 1989. The 
hearing record will remain open for written com- 
ments from January 16, 1989 through February 
IS, 1989. Written comments must be sent to the 
above address and must stale the rulefsj to which 
the comments are addressed. Fiscal information 
on these rules is also available from the same ad- 
dress. 

CHAPTER 14 - >JENT.\L UE.AI.TFl: GENER.AL 

SLBCHAPTER 14G - COMMITTEES AND 
PROCEDIRES 

SECTION .0100 - PI RPOSE: SCOPE: 
DEEINITIONS 



H90 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



.0101 PURPOSE AND SCOPE 

(a) The purpose of the rules in Subchapters 
14G, I4H, 141 and 14J of this Chapter is to set 
forth regulations governing human rights for cli- 
ents in division state facilities. The state facilities 
governed by these Rules are the regional psychi- 
atric hospitals, mental retardation centers, alco- 
holic rehabilitation centers, Wright School, the 
North Carolina Special Care Center at Wilson, 
Whitaker School, and any other like state owned 
and operated institutions, hospitals, centers or 
schools that may be established under the ad- 
ministration of the division. In addition to these 
Rules, Ae each state facility shall follow the 
North Carolina General Statutes regarding cli- 
ents' rights which are specified in Article 3 of 
Chapter 122C. 

(b) The division shall submit an annual report 
to the commission on the implementation of the 
rules in Subchapters 14G, 14H. 141 and 14J of 
this Chapter. 



Statutorv Authoritv G.S. I22C-5I; 
1 43 B- 17; I43B-I47. 



I3IE-67: 



.0102 DEFINITIONS 

(a) In addition to the definitions contained in 
this Rule, the terms defined in Cj.S. I22C-3, 
122C-4 and 122C- 53(f) also apply to all rules in 
Subchapters 14G, 1411, 141, and 14J of this 
Chapter. 

(b) As used in the rules in Subchapters 14G, 
14H, 141 and 14J of this Chapter, the following 
terms have the meanings specified: 

(1) "Abuse" means the infliction of physical 
or mental pain or injury by other than 
accidental means, or unreasonable con- 
fmcment, or the deprivation by an em- 
ployee of services which are necessary to 
the mental and physical health of the cli- 
ent. Temporary discomfort that is part 
of an approved and documented treat- 
ment plan or use of a documented emer- 
gency procedure shall not be considered 
abuse. 

(2) "Basic necessities" means the essential 
items or substances needed to support life 
and health which include, but are not 
limited to, a nutritionally sound diet bal- 
anced during three meals per day, access 
to water and batliroom facilities at fre- 
quent intervals, seasonable clothing, 
medications to control seiz.ures, diabetes 
and other like physical health conditions, 
and frequent access to social contacts. 

(3) "C e nter" m e ans mental retardation center 
ae specified m GrS^ 122 69. "Client 



record" means any record made of confi- 
dential information. 

(4) "Client" moano a poroon admitted te a fo- 
cility fof caro, evaluation, treatment, 1»- 
bilitation eF rehabilitation. "Chnically 
privileged" means authorization by the 
state facility director for a qualified pro- 
fessional to provide specific 
treatment /habilitation services to clients, 
within well-defmed limits, based on the 
professional's education, training, experi- 
ence, competence and judgment. 

f§^ "Client Advocate" moons any o no who 
opoolcs e» bohalf ef a client including kt- 
cility aft4 other state omployoos identified 

volunteers »f aay other porsono who ate 
identified aft4 rooognia e4 as advocates as 
stated i» written descriptions ef their d«- 
ti^Sr As us e d m these Rules cli e nt advo 
cates shall h©*- include persons who have 
es¥f treatment responsibilities fof tfee eli- 
eftt rocoiving the ad^'ocacy sor^'ices. 
f6^ (5} "Complaint" means an informal verbal 
or written expression of dissatisfaction, 
discontent, or protest by a client concern- 
ing a situation within the jurisdiction of 
the slate facility. A complaint would 
usually but not necessarily precede a 
grievance. 

(6) "Consent" means concurrence by a client 
or his her legally responsible person fol- 
lowing receipt of sufficient information by 
the qualified professional who wiU ad- 
minister the proposed treatment or pro- 
cedure. Informed consent implies that the 
client or his/her legally responsible person 
was provided with sufficient information 
concerning proposed treatment, including 
both benefits and risks, in order to make 
an educated decision with regard to such 
treatment. 

(7) "Dangerous articles or substances" 
means, but is not limited to, any weapon 
or potential weapon, heavy blunt object, 
sharp objects, potentially harmful chemi- 
cals, or drugs of any sort, including alco- 
hol. 

(^ "Defacto Incompetent" means a client 
v i 'ho is detenmnod te be incompetent by 
hi ' v h e r treatment t e am b«4- v4*» has ft»t- 
been adjudicated incompetent under 
Chapt e r -^ ef the General Statutes. 

(^ "Department" means Departm e nt ef 
Human Resources as estabhi . hed ift 
Chapter M3H ef Ae General Statutes 
rJ ' Keoutivo Organigation Act »f 1973. 



NORTH CAROLINA RECISTER 



891 



PROPOSED RULES 



fW^ (8} "Deputy Director" means a member 
of the management stail of the division »f 
Mental Health, M e ntal Pt e tardation (*ft4 
Subf . tanc e Abuco Sor i 'iooo, with responsi- 
bility for the state facilities relative to a 
specific »ft4 pro gram G within thoir disabil- 
ity area. Such directors may include the 
Deputy Director of Mental Health, Dep- 
uty Director of Mental Retardation, Dep- 
uty Director of Substance Abuse, Deputy 
Director fof OporationG, afi4 Deputy Di- 
roctor fof Medical Sonicoo, or such depu- 
ty's designee. 

(-44-^ (9| "Director of Clinical Ser\'ices" means 
Medical Director, Director of Medical 
Services or such person acting in the po- 
sition of director of clinical services, or 
his her designee. 

f4^ "Divii i ion" meanf i the Divir . ion &f Mental 
Health, Mental Retardation aft4 Sub 
otance i\buGe Seniceo ef tiie Deportment 
©f II u man Resources. 

(44-^ ( 111) "Division Director" means the direc- 
tor of the division t»f Mental H e alth. 
Mental Retardation aft4 Substance Abus e 
Senicos ef Ae Department »f Human 
Ro ' jOuroeG or his her designee. 

fl-H (II) "Emergency" m FaciUli e s Other 
Than Regional Hospitals means a situ- 
ation in a stale facility in which a client is 
in imminent danger of causing abuse or 
injury to self or others, or danger ©f cauG 
H*g when substantial property damage is 
occurring as a result of unexpected and 
se\ere forms of inappropriate behavior, 
unless there i* and rapid intervention by 
the staff is needed. [See I^M (23) of this 
Rule for definition of medical emergency). 

(-!-§-)• "Emergency m Regional Hospitals" 
moano a situation m which a client » i» 
imminent danger ef oauoing injur i to eetf 
e* others Bf danger ef causing substantial 
property damage ef senous disruption ef 
Ae therapeutic en'rironmont to tfee e xt e nt 
tba* it- would infnnge &» tbe rights ef 
oth e r clients unless there i^ rapid inter 
vention bv 0^ ?.tttffr ^S^ (44f ef tte. Rriil^ 
fof definition 9ii medical emergency |. 
(12) "Iimergency surger," means an op- 
eration or surgerv' performed in a medical 
emergency |as detlned in (444 (23) of this 
Rule] where informed consent cannot be 
obtained from an authorized person, as 
speciffed in G.S. 90-21.13, because the 
dela\' would seriously worsen the physical 
condition or endanger the life of the client. 

(13) "Exclusionary" time-out" means the re- 
moval of a client to a separate area or 



/ 1 <; . 



room from which exit is not barred for the 
purpose of modifying behavior. 

f4?) (14) "Exploitation" means the illegal or 
improper use of a client or his/her re- 
sources for another person's profit, busi- 
ness or advantage. "Exploitation" 
includes borrowing or taking personal 
property from a cbent. 

fW) "I'acility" m e ans stat© ownod afi4 opor 
*te4 psychiatric hospitalG, state alcohoUo 
rehabilitation oontorG, Wnght School, 
WTiitalcer School, North Carolina Special 
Care C'Onter, mental retardation centorB 
eg^ aft¥ other !*}*« institutions, hoopitalo. 
centers e* Gchoolo ti»t- may be ootablishod 
under the adminiGtration 6^^ Ae di' i 'ision. 

fW^ "Facility Director" meano t4*e chief ad- 
ministrativo officer ef manager &f a facility 
ef his, ' her dosignoo. 

f3% (15) "Grievance" means a formal written 
complaint by or on behalf of a client 
concerning a circumstance within the ju- 
risdiction of the state facility thought to 
be unjust, injurious, ef a violation of eli- 
e nt s client rights. A gnevance would 
usually but not necessarily foUow a com- 
plaint. 

(-24-^ "Guardian" moans a person appointed 
by a court ei competent jurisdiction fof 
tbe purpose e4" performmg duties related 
te- tfee core, custody e* control ef Ae eii- 
efrt- V i hich may include, btrt- i* net- limited 
te-r consenting fof medical ' Gurgioal prooe 
duren ©f treatm e nt procedures afi4 handl 
iftg i»f buGiness t»f l e gal affairG. tft tl+e ease 
ef a minor, "guardian" meano a parent »f 
person standing m loco parentis (exolud 
»f tbe faoiUt; . ). 

(-32^ "HabiUtation ' meana education, training 
and" or treatment undertaken to develop 
tbe capabilities &f t+te client. 

(-3^ ( 16) "Human Rights Advisory 
Committee" means a committee, sf the 
oommitteeo deoignee, appointed by the 
secretary, to provide aa additional oafo 
guard toward the eft4 ©f protecting the 
human a«4 Gmi rights ©f clients, act in 
an advisory capacity regarding the pro- 
tection of clients' nghts. 

(34^ "Incompetent Cliont" is a client who has 
been adjudicated incompetent under 
Chapt e r 4^ ef the General Statutes aft4 
has ftot- been restored to le«4 capacity 
according to Chapter 4§ ©f the General 
Statutes. 

f4i-) (17) "Independent psychiatric 
consultant" means a licensed psychiatrist 
not on the staff of the state facility in 



892 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



which the client is being treated. The 
psychiatrist may be in private practice, or 
be employed by another state ef a privat e 
inpatient ef outpationt facility, or be em- 
ployed by a facihty other than a state fa- 
cility as defmed in G.S. 122C-3(T4). 

(36) (18) "Interpreter services" means special- 
ized communication services provided for 
the hearing impaired by certified inter- 
preters. 

(3^ (19) "Involuntary cbent" means a person 
admitted to any regional psychiatric hos- 
pital or alcohoUc rehabilitation center un- 
der the provisions of Article s 5, A »f 44 
Parts L 8 or 9 of Chapter 122 C of the 
General Statutes ©f under Gr^ 
123 65.1 1(c) and includes but it is not 
limited to clients detained pending a dis- 
trict court hearing and clients involuntar- 
ily committed after a district court 
hearing. This term shall also include in- 
dividuals who are defendants in criminal 
actions and are being evaluated in a state 
facility for mental responsibility and/or 
mental competency as a part of such 
criminal proceedings as specified in G.S. 
15A-1002 unless a valid order providing 
otherwise is issued from a court of com- 
petent jurisdiction and the civil commit- 
ment of defendants found not guilty by 
reason of insanity as specified in G.S. 
15A-1321. 

(20) "Isolation time-out" means the removal 
of a client to a separate room from which 
exit is barred but which is not locked and 
where there is continuous supervision by 
staff for the purpose of modifying behav- 
ior. 

(3^ "Lx'gaUy Ror f ponoiblo Poroon" muanu tfe» 
person »f group with legal authority t» 
oonnent ©f rofuoo treatment &f hubili 
tation. ef othonvino legally aet- ©» behalf 
ef a client. Such person shall ber th<* eli- 
6ftt if the client is a competent adult; the 
par e nt »f a minor client, unless another 
person ©f agency ha* been awarded 
guardianship; »f the guardian ef »» *«- 
competent oUent. 

(39) (21) "Major physical injury" means dam- 
age caused to the body resulting in sub- 
stantial bleeding or contusion of tissues; 
fracture of a bone; damage to internal or- 
gans; loss of consciousness; loss of normal 
neurological function (inabihty to move 
or coordinate movement); or any other 
painful condition caused by such injury. 

(^0) ".Mechanical Restraint" moiins limitation 
ef the client's freedom frf mos'ement with 



the intent ef controlling b e havior by me- 
chanioal doviooo which include, b«t afe 
nsi limited ter cuffo, onldo strapo, ohooto, 
Bf rootraining ohirto. fc dees net include 
th e rapeutic restraint bf enabling devicoo 
used fef modiool conditions ef t» assist a 
non ambulator)' client te maintain a 

include handcuffs used fef escorting fmt- 
posoB with foronsio chonts. 

(^4) (22) "Medical emergency" means a situ- 
ation where the client is unconscious, ill, 
or injured, and the reasonably apparent 
circumstances require prompt decisions 
and actions in medical or other health 
care, and the necessity of immediate 
health care treatment is so reasonably ap- 
parent that any delay in the rendering of 
the treatment would seriously worsen the 
physical condition or endanger the life of 
the client. 

(^3) (23) "Minimal risk research" means that 
the risks of harm anticipated in the pro- 
posed research are not greater, considering 
probability and magnitude, than those 
ordinarily encountered in daily hfc or 
during the performance of routine phys- 
ical or psychological examinations or 
tests. 

(^^ (24) "Minor client" means a person under 
1 8 years of age who has not been married 
or who has not been emancipated by a 
decree issued by a court of competent ju- 
risdiction or is not a member of the armed 
forces. 

(44) (25) "Neglect" means the failure to pro- 
vide care or services necessary to maintain 
the mental health, physical health and 
well-being of the client. 

(26) "Neuroleptic medication" means a cate- 
gory of psychotropic drugs used to treat 
schizophrenia and related disorders. 
Neuroleptics are the only category of 
psychotropic drugs with long-term side 
effects of major consequence (e.g., tardive 
dyskinesia). Examples of neuroleptic 
medications are Chlorpromazine, 

Thioridazine and Maloperidol. 

(4^ "N e xt ef Kin" m e ans that person »f 
persons se- designated by the client ef 
his 'her guardian »f parent upon, »f sub 
sequent ter admission fof treatment ef 
habihtation at a facihty \Gr^ 132 36(o)|. 

(44) (27) "Normalization" means the principle 
of helping the client to obtain an existence 
as close to normal as possible, taking into 
consideration the client's disabilities and 
potential, by making available to him/her 



NORTH CAROLINA REGISTER 



893 



PROPOSED RULES 



patterns and conditions of even'day life 
that arc as close as possible to the norms 
and patterns of the mainstream of society. 

(4^ "Paront" mcano the biologicul e* 
adoptivo moth e r »f father ©f a minor eli- 
«*4-r »f Ae puroon otanding » leee 
parontic ' (oxcluding the facility), ef the le- 
s4 guardian »f a- minor cli e nt. 

(28) "Person standing m loco parentis" means 
one who has put himseli" in the place of a 
lawful parent by assuming the rights and 
obligations of a parent without formal 
adoption. 

f^^ "Physical Rootramt" m e an - j limitation ei 
the client "fj freedom &f movement h¥ 
phy i ically holding Bf f . ubduing the client. 

f:iiif "Phyr . ician ' meanf . a p e r ^. on IicenLK'd te 
practic e medicine wt North Carolina m- 
cluding a doctor el medicine C ' pecializing 
m the fieW- t*f paychiutp . '. 

(ZQ) "Protective devices" means an inter- 
\ention which provides support for weak 
and feeble clients or enhances the safetv 



of beha\'iorallv disordered clients 
dcMces mav mc 



Such 



:lude 



pose\ 



vests, gen- 
chairs or table top chairs to pro\ide sup- 
port and safctN' for clients with major 
ph\Mcal handicaps; de\ices such as hel- 
mets and mittens for self-mjunouN beha\- 
iors; or de\ices such as solt ties used to 
pre\ent medicalK lU clients from remov- 
ing intra\enous tubes. indwelUng 
catheters, cardiac monitor electrodes 
similar medical de\ices. 



or 



(44^ (3(1) "PsNchosurgcPv " means surgical pro- 
cedures for the intervention in or alter- 
ation of a mental, emotional or behavior 
disorder. 

(-44-f ( ■'^ 1) "Psychotropic medication" means 
medication with the primary function of 
treating mental illness, personality or be- 
ha\ior disorders. It includes, but is not 
limited to, antipsychotics, anti- 
depressants, minor tranquilizers and 
lithium. 

f4^ (32) "Quahfied professional" means any 
person with appropriate training or expc- 
nence in the professional fields of mental 
health care, mental illness, mental retar- 
dation, or substance abuse, including but 
not limited to, physicians, psychologists, 
social workers, registered nurses, qualified 
mental retardation professionals and 
qualified alcohohsm or drug abuse pro- 
fessionals, as these terms are defined in 10 
NCAC UK .0103. 4^4 t£>4^ "Standordo 
fof .\rea I'rogramii aft4 Iheir (\mtract 
■\aencio ' : i ' ("Licensure Rules for Mental 



Health, .Mental Retardation and Other 
Developmental Disabilities, and Sub- 
stance Abuse facilities," division publica- 
tion APSM 4^-4 4(>v2 ). In addition, 
qualified professionals shall include special 
education instructors, physical therapists, 
occupational therapists, speech therapists 
and any other recognized professional 
group designated by the state facility di- 
rector. 

fist * 1-^ Pii'^rj'i mt^'"tfi r ""-«** --^-r^ ■-u-'j^.-^ 1 1«^ t .-tf ■-• 1 1 .-^ .-^ » 

information. 

(33) "Regional alcoholic rehabilitation 
center" means a state facHitv for substance 
abusers as specified in G.S. 
122C-lSl(a)(3). 

(34) "Regional mental retardation center" 
means a state facility for the mentally re- 
tarded as specilied in G.S. 122C-lSl(a)(2). 

(35) "Regional psvchiatnc hospital" means a 
state facility for the mentally ill as speci- 
fied in G.S. 122C-181(a)(l). 

f44^ (36) "Representative payee" means the 
person, group, or facility designated by a 
funding source, such as Supplemental Se- 
curity Income (SSI), to receive and handle 
funds accordmg to the guidelines of the 
source on behalf of a client. 

f-4-§4 (37) "Research" means inquip,' in\'olving 
a tnal or special observation made under 
conditions determined by the investigator 
to confirm or dispro%e an hypothesis or 
to explicate some principle or effect. 

(44) (38) "Respite client" means a client ad- 
mitted to a mental retardation center for 
a short-term period, normally not to ex- 
ceed 30 days. The primary purpose of 
such admission is to pro\'ide a temporary 
interval of rest or relief for the cUent's 
regular caretaker. 

(39) "Responsible professional" shall have the 
meaning as specified in G.S. 122C-3 ex- 
cept the "responsible professional" shall 
also be a qualified professional as defmed 
in Subparagraph (b)(33) in this Rule. 

(40) "Restraint" means the limitation of one's 
freedom of movement. In accordance 
with G.S. 122C-60, restraint mcludes the 
following: 

(.A) mechanical restraint which is restraining 
a client with the mtcnt of controlling be- 
havior with mechanical de\ices which m- 



clude. but are not limited to 
sheet 



:utfs. ankle 



straps 

does not includ 



or restraining shirts. This 



handcuffs used for the 

purpose of escortmg forensic clients: 
(B) ph\sical restraint which is restraining a 
client by phvsicallv holding or subduing 



S94 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



the client until he/she is calm. TTiis does 
not refer to the utilization of those pro- 
tective intervention techniques (I^IT), as 
specified in the "Protective Intervention 
Course Manual", division publication 
APSM 80-2, relative to transporting a cli^ 
ent to seclusion or isolation time-out or 
applying mechanical restraints. 
(4^ (41) "Seclusion" means isolating a client 
in a separate locked room ©f a room from 
which ho r . ho cannot esit- for the purpose 
of controlling a client's behavior. Seclu- 
sion shall not include the following in the 
forensic unit at Dorothea Dix Hospital: 
the routine use of locked cells, isolation 
due to escape attempts, security risks or 
juvenile court orders requiring the sepa- 
ration of juveniles from adults. 

"State facility director" means the chief 
administrative ofliccr or manager of a 
stale facilitv or his her designee. 



(42) 

I AQ\ 

44) 






f^ 



f^ 



(482 



f^ 



"Socri'tap i '" mounf . tfee S e cr e tary &f the 
Department »f 1 lumaxi ReoourcL's ef 
hiii hor dc ' .ognoo. 

(43) "Strike" means, but is not limited to, 
hitting, kicking, slapping or beating 
vshethcr done with a part of one's body 
or with an object. 

"Time-out" means the remo\al of a cli- 
ent from other clients to another space 
within the same activity area for the pur- 
pose of modifying behavior. 

(45) "I'reatment" means the act, method, 
or manner of habilitating or rehabilitating, 
canng for or managing a client's physical 
or mental problems. 

(46) "Treatment plan" means a written 
indi\idual plan of treatment or habili- 
tation for each client to be undertaken by 
the treatment team and includes any doc- 
umentation of restriction of client's rights. 

(47) "Treatment team" means an inter- 
disciplinary group of qualified profes- 
sionals sufficient in number and variety 
by discipline to adequately assess and ad- 
dress the identified needs of the client. 

"Init" means an integral component of 
a state facility distinctly established tor the 
deliserv of one or more elements of ser- 
\'ice to which specific staff and space are 
assigned, and for which responsibility has 
been clearly assigned to a director, super- 
visor, administrator, or manager. 
(4^)) "Voluntary client" means a person 
willingly admitted to a state facility fof 
e valuation, treat mont ©f habilitation aH4 
includes btrt- i* R»t- limited te tho ' . i O ad- 
mitt^ under the provisions of Article X 



Parts 2, 3, 4 or 5 of Chapter 122C of the 
General Statutes. GtSt Chapter J42t Af- 
ticloB 47 9 Bf 12A. J Also included are mi- 
R©f* voluntarily admittod by their paronto 
aR4 poroono adjudicated incompetent v©!- 
untarily admitted *«• a facility fey their 
guardiano. 

Statutory Authority G.S. I22C-3; I22C-4; 
I22C-5I; l22C-53(f); I3IE-67; I43B-I47. 

SECTION .0200 - HUMAN RIGHTS ADVISORY 
COMMITTEES 

.0201 PURPOSE OF HUMAN RIGHTS 
ADVISORY COMMITTEES 

A human rights advisory committee shall be 
established i» aH facilitioo at each state facility to 
provide an additional safeguard for protecting the 
human, civU, legal and treatment rights of clients 
who, due to impairments resulting from mental 
retardation, mental illness or substance abuse, 
may be less able to articulate and exercise their 
legal entitlements than those not impaired. 



Statutory Authority 
J 43 B- J 47. 



G.S. I22C-64; I3IE-67; 



.0202 MEMBERSHIP 

(a) Members of human rights advisory com- 
mittees shall be named appointed by the secre- 
tary. Committoofi may recommond «*«*• 
memborc i te tlw secretary. 

(b) Recommendations for committee appoint- 
ments and the appointment process shall be as 
follows: 

( 1) The state facility director shall maintain a 
schedule of the tenns of appointment for 
committee members and shall request 
names of possible appointees from volun- 
tary groups serving the mentally ill, men- 
tally retarded or substance abusers, as 
appropriate, as well as from the chair- 



person of the state facility human rights 
advisory' committee six months prior to 
the expiration of a committee member's 
term. 1 he state facility director shall 
submit these nominations, as well as any 
additional nominations, to the appropri- 
ate deputy director in the division five 
months prior to the expiration of the 
committee member's term. 
(2) Within two weeks following receipt of the 
nominations, the deputy director shall 
submit the committee and voluntary 
group recommendations for nominations, 
as well as any other nominations sup- 
ported by the deputy director, to the di\i- 
sion director. 



NORTH CAROLINA REGISTER 



895 



PROPOSED RULES 



(3) The disision director shall submit the 
committee and voluntary group recomm- 
endations, as well as any other nomi- 
nations he she supports, to the secretary 
four months prior to the expiation of the 
committee member's term of office. 

(4) I'he secretary" shall contact his/her choices 
for potential appointees, explain commit- 
tee member responsibilities and confirm 
appointments in writing. 

(5) "I he secretary' shall notify the division di- 
rector and the committee chairperson of 
confirmed committee appointments and 
the tenn of otfice for appointees two 
months pnor to the expiration of the 
committee member's term. 



(6) The dnision director shall notify the state 
facility director of the appointment. 

fb^ (c) Appomtments shall be made with an ef- 
fort to consider the geographic distribution, race 
and sex composition of the human rights ad\'i- 
sor%' committees. 

ft^ (d] Members shall represent only one of the 
organizations or professional groups indicated in 
(e), (f), (g), (h| and (i) of this Rule during any 
single term in their capacity as human rights ad- 
visorN' committee members. 

f4^ (£2 Each regional psychiatnc hospital shall 
have a committee consisting of ten members, 
none of whom shall be currenth employed by 
the division or attomc\ i^enerals office. 

(1) AH members shall be knowledgeable about 

ment:d health mental illness issues as evi- 
denced by interest, expenence or educa- 
tion. A^^ momben i hip ■ - i hall includ e at- 
loa '. t L'ight puri i on ?! fte+ employed h^ At> 
di' i i ' .uon includmg fonnor employeof . »f 
t4+e facility. AppointooL . 'i haU includo Hvo 
member? ! e+' a mental health aj: . ? . ociation: 
trH+e member ef A# AL i Sociution fe* Re- 
tarded ("iti/ent ' : »»& p a rson who t* either 
a- client . lormer client ef family member 
&i a client »4 a regional ho^ . pital: efte seft- 
jef citizen: aR4 e«e person whe- is a 

rt-i . ^T-»-i V-. . !«- r~i T - > «-. -^ J-/ 1 >-^ » .-' j-i t- »^ j- ."* t . ai- f i .-\ »-l ■^\ I ■ t-w- t^ i i r^ 
l\ l\^ 1 1 l\.'\Jl \J I CT pTTrCTTTTT CT I'l ^^'Jk_ .'Ull.'II VLx, CrCvTTT 

i i ening children with f . p e cial neodf . . 
Membert ' hip should include e«e attorney 
' . ' . ho i*T ftot- employed by tfet» Attorn e y 
Cienerals Office. 44*t» special counsel a*- 
signed to Ae hospital by- tfee senior supo 

r-t i-ir i^i-\j 1 T-f < 1 1 ,-I ■ -I -1 j"\ 1 t It .-t « 1 1 .-1 1 ■ '< --1 I . -1 1 .- i »-■ , ■* T-n ■"■ i r 
rTTTT CrmTT J UU i—.\. TTT T. 1 IV 1 UTJ IVITll TJ IJI 1 I \\. I 1 1 lU T 

bi* in' i ited te sene m i^ capacity. Ai- 
temati' i ely. A# attorney representative 
may be dra' . ' .- n from t4w region served. 

(2) Appointments shall be made with an effort 

to consider representation of the needs 
and charactenstics of the state facility cli- 
ents. 44+e membership shall include e«i* 



(41 
(51 



health safe ' . vorkor from ^fe« facility aft4 
efte m e mb e r at- largo wfee may be conoid 
efe4 as ©ft© »f tfe© twe- disioion e mployooo 
ef »ne »f the eight non division employ 

Seven members shall be appointed at- 



large. 
At least 



two members shall be clients 



and/or farruly members of clients. 

One member shall be a hcensed attorney. 



(ef (fl Each regional mental retardation center 
shall have a committee consisting of ten mem- 
bers, none of whom fpts^ shall be currently em- 
ployed by the division. Names shall be r e quootod 
from the North Carolina Association fof Re- 
tarded Citizens aft4 other voluntary groups ser . ' 
iftg tbe mentally retarded a* w^ as from the 
m e ntal health, mental retardation ^PfA substance 
abus e syst e m such as directors <^ regional mental 
retardation centers. 



(1) 



Four of the committee members shall be 
parents ei retarded persons, retarded pef- 
60 ns themselves aft4 at l e ast e«e former 
resident ef a regional mental retardation 

whose mentally retarded children resid e 
aft4 4» ft»t reside » tl^ facility, include 
the legally responsible person(s) of per- 
sons with mental retardation who may or 
may not reside in a state facihtv, persons 
with mental retardation, and at least one 
client of a regional mental retardation 
center. 



(2) 



(3) 



(4) 



Three members shall be professionals from 

three different associated fields such as 

social work, education, psychology or 

medicine. 

One member shall be a licensed attorney. 

who is ftet employed by tbe Attorney 

General's Office. 

Two members shall be selected at large. 
{^ ("I Each regional alcoholic rehabilitation 
center shall ha\'e a committee consisting of five 
members, none of whom shall be currently em- 
ployed by the division. ¥he m e mb e rship shall 
include at least fowf persons »et employed by t^ 
di' . ision. 

(1) Two persons shall be members of volun- 
tary groups representing the interests of 
alcoholics. persons having substance 
abuse problems. 

(2) One person shall be a former client or 
family member of a client &f former client 
of an alcoholic rehabilitation center. 

(^ Qfte member shall be selected at ku-go aft4 
&fte member f»ay be employed by tfee fo- 
ciUty. 

(Ti) Two members shall be selected at -large. 



S96 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



fg) (h) Wright School, Whitaker School and any 
other like state facility established and adminis- 
tered by the division to serve emotionally dis- 
turbed children and adolescents each shall have 
a committee consisting of five members, none of 
whom shall be currently employed by the divi- 
sion. ^fhe> momborohip oholl includo at l e ast fewf 
poroono ftot- omployod fey tb« divioion. 

(1) Two persons shall be members of volun- 
tary groups representing the interest of 
children and adolescents with special 
needs. 

(2) One person shall be a paront the legally 
responsible person of a client ef former 
client of a state facility for emotionally 
disturbed children. 

(3) Qfte mombor eholl be ooloctod at largo aft4 
eft© mombor f«ay- b« omployod hy the fe- 
cility. 

(3) Two members shall be selected at -large. 
(fe) (ij North Carolina Special Care Center at 
Wilson and any other like state facility estab- 
lished and administered by the division shall have 
a committee consisting of five members, none of 
whom shall be currently employed by the divi- 
sion, '-i^h^ momborohip shall include at least few 
poroons ftet omployod hy the divioion. 

(1) ©fte porf p on ohall be a mombor ef a montal 

health aooociation. Qfte person ohaU be a 
oonior citL'.en aft4 ©fte peroon ohall be a 
family member &f a cliont ef former client 
©f the facility. All members shall be 
knowledgeable about mental health and 
nursing care issues as evidenced by inter- 
est, experience or education. 

(2) Q«e member shaii be oelocted at larg e aft4 

efte mombor may be omployod at the fe- 
oility. Four members shall be appointed 
at -large. 

(3) At least one member shall be a client or 
family member of a client. 

Statutory Authority G.S. I22C-64: 131E-67; 
I43B-I0; I43B-I47. 

.0203 EX OFFICIO MEMBERSHIP 

(a) A An internal client advocate may serve as 
a non-voting member of each human rights ad- 
visory committee. 

(b) In addition to the members appointed by 
the secretan,', the chairperson may designate 
other non-voting ex officio members to assist the 
committee. Fx officio members may be em- 
ployees of the division. 

Statutory Authority G.S. I22C-64; I31E-67; 
I43B-147. 



.0204 TERMS OF OFFICE 

(a) Memb e rs aft4 offiooro oonTng upon the ef- 
foctivo date ef this Rule »» human righto com 
mittoQO at the poyohiatrio hospitals and montal 
retardation c e nt e rs a* ootablishod by DHR ©i- 
rootivo 3 77: Advisor)' Councils shall net be ai- 
foctod by afty provioiono ef this Section during 
the remainder ef thoir current terms. 

(b) (a) All members shall be appointed to serve 
three year terms except for the initial terms at 
state facilities which de did not have human 
rights advisory committees as established by 
DHR Directiv e 3 77: Advisory Counoilo. upon 
the original effective date of these rules. 

(e) (b} Initial appointments for each of the 6¥e 
mombor committees established under Paragraph 
(a) of this Rule by this Section shall be as fol- 
lows; 

(1) One member shall serve a four-year term, 
expiring June 30. 

(2) Two members shall serve a three-year 
term, expiring June 30. 

(3) One member shall serve a two-year term, 
expiring June 30. 

(4) One member shall serve a one-year term, 
expiring June 30. 

(4) (c) Members may be appointed for no more 
than two consecutive three-year terms. 

(e^ (d) If a vacancy occurs due to death, resig- 
nation or disqualification, the human rights ad- 
visory committee chairperson shall notify the 
oecrotary state facility director who shall initiate 
procedures to fill the \'acancv in accordance with 
Rule .0202(b) in this Section, have the authority 
t» fiii the vacancy. .Members appointed in this 
manner shall serve out the term of the of mem- 
bership represented by the member whose place 
they are selected to fiU. 

(e) Human Rights Advisory Committee mem- 
bers whose appointment terms have expired may 
continue to serve on the committee until such 
time that the committee member is notified by 
the state facihty director that another appoint- 
ment has been made and the committee mem- 
ber's term of appointment has officially expired. 

(f) If a member misses three consecutive 
meetings without being excused by the chair- 
person, the chairperson shall notify the secretary 
who may disqualify the member upon written 
notification. 

(g) The secretary shall have the authority to 
remove any member of a human rights advisory 
committee from office for good cause. 



Statutory Authority G.S. 
143B-I0; I43B-I47. 

.0205 OFFICERS 



I22C-64: I3IE-67; 



NORTH CAROLINA REGISTER 



897 



PROPOSED RULES 



(a) Each human rights advisory committee 
shall elect by a majority a chairperson to serve for 
a period of two years. No person shall serve 
more than two consecutive terms as chairperson. 
The chairperson shall be a committee member 
who HO^ be an- omployoo ef the division, does 
not work directly with clients at the state facility. 

(b) Other officers may be elected as needed 
based on a majority vote of the committee. 

Stalutory Authority G.S. I22C-64; I3IE-67; 
I43B-I47. 

.0206 MEETINGS 

(a) Each human rights advisory committee 
shall meet at least monthly unless an alternative 
schedule is approved by the secretary but in no 
case less than six times per year. Committees 
may meet more often as necessary at the call of 
the chairperson. The chairperson shall call a 
meeting of the committee at any time such is re- 
quested by four or more members of a ten- 
member committee or two or more members of 
a five-member comnuttee. 

(b) y\ majority of each committee shall consti- 
tute a quorum for the transaction of business. 

(c) Human rights ad\isorv committees as pub- 
lic bodies arc subject to open meetings as speci- 
fied in G.S. 143-318.9 through 143-318.12. Due 
to the nature of the deliberations of human rights 
advisor\" committees, it is anticipated that some 
of the issues would be discussed in executive 
session in accordance with G.S. 143-318.1 1(a)(7) 
and (a)( 12). The chairperson shall file a schedule 
of regular meetings with the Secretary of State as 
specified in G.S. 143-318.12. 

Statutory Authority G.S. 122C-64; I3IE-67; 
1438-10: 1 438- 147. 

.0207 DUTIES 

(a) The duties of the human rights advisory 
committees > ilui.ll include' btrt aft» net- limitL * d tsr 
are as follows: 

( 1 ) monitonnu review of compliance with laws 

m G.S. r22 C , Article 3, l^art* 3 a«4 ^ 
dealing with the rights of chcnts, and 
monitoring »«¥ human righto ruloo 
promulgated by tl«» disi ^f ion; reviewing 
the state facility's compliance with the 
human nghts rules in this Subchapter and 
Subchapter 1411 through 14.1 of this 
Chapter; 

(2) reviewing monitoring and assessing the 
efficiency of existing and proposed meth- 
ods and procedures for protectmg the 
rights of clients of their respective state 
facilities; 



(3) serving as an independent review body to 
hear and make recommendations con- 
cerning alleged violations of the rights of 
individuals and groups brought by clients, 
client advocates, parents, guardians, Fitaff, 
state facility employees, or others, in 
compliance with Rule .0209 of this Sec- 
tion for any necessary review of the client 
record; 

(4) reviewing programs and services which 
that deal with the legal and human rights 
of clients; 

(5) reviewing eases of alleged abuse, neglect 
or exploitation or failure to provide ser- 
vices of whatever nature brought by cli- 
ents, chent advocates, parents, guardians, 
staff state facility employees, or others, in 
compliance with Rule .0209 of this Sec- 
tion for any necessary review of the chent 
record; 

(6) reviewing cases brought by clients, chent 
advocates, parents, guardians, staff state 
facility employees, or others regarding the 
use of seclusion, physical or mechanical 
restraint, intrusive or aversive procedures, 
electroconvulsive therapy, medication 
prescribed above recommended dosages 
as specified in 10 NCAC 14F .0600 or any 
procedures carried out against the wUl of 
the client. The committee may determine 
the extent of the review, including but not 
hmited to statistical review and individual 
case review involving a review in compU- 
ance with Rule .0209 of this Section of the 
chent record; 

(7) reviewing complaints, grievances or any 
other chent rights issues of concern 
brought by chents, chent advocates, par- 
ents, guardians, staff state facility employ- 
ees, or others in comphance with Rule 
.0209 of this Section for any necessary re- 
view of the chent record; and 

(8) reviewing any issues of concern brought 
by the state facihty director, division di- 
rector, a deputy director, or the secretary. 

(b) The duties listed in Paragraph (a) of this 
Rule shall not be interpreted to allow human 
rights advisory committees to concern themselves 
with the management of the respective state fa- 
cihties except where there is an issue of violation 
of a client's rights. 

(c) Annually, by September 1, each committee 
shall submit, through the division director, to the 
secretary a report of its activities, accomphsh- 
ments, and recommendations for the previous 
year, .lulv ]_ through June 30. 



S9S 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Statutory Authority G.S. I22C-64; I3IE-67: 
I43B-I0: I43B-I47. 

.0208 PROCEDl RES 

(a) There shall be a written agreement govern- 
ing the relationship and responsibilities of the 
state facility director, human rights advisor\' 
committee and chcnt advocate. Such agreement 
may be superseded by any written agreements 
between the division and the Governor's Advo- 
cacy Council tor Persons with Disabilities. 

(b) If the majonty of the human rights advisory 
committee feels that an issue requires r e m e dial 
action, the chairperson of the committee shall 
submit a written statement regarding the issue to 
the state facility director and indicate a desired 
response date. Ihe issue shall be brought to the 
attention of the state facility director. If the 
committee is not satisfied with the actions of the 
state facility director, the issue shall be brought 
to the attention of the division director and the 
appropriate deputy director simultaneously. If 
the committee is not satisfied with the action of 
the division director or the deputy director in- 
volved, the issue shall be brought to the attention 
of the secretary. 

(c) If the majonty of the committee votes that 
an issue does not require romcdial action, but 
two or more members feel strongly that some 
action is necessary, these members may submit 
a minority report to the state facility director, the 
division director and deputy director, and the 
secretary in the same manner as a majority deci- 
sion. 

(d) In cases deemed appropriate by the com- 
mittee, steps in the communications procedure 
as outline in Paragraph (b) of this Rule may be 
omitted, provided that the person in authority in 
each omitted step is notified in writing. 

(e) The committee may also seek help in solv- 
ing problems from the Governor's Advocacy 
Council for Persons With Disabilities, Gover- 
nor's Advocacy Council on Children and Youth, 
the Commission for .Mental Health, .Vlental Re- 
tardation and Substance Abuse Services, and/or 
the Dovolopm e ntul Dii . abilitioo Council on De- 
velopmental Disabilities, ef any other source 
whijii f i uch action » agreed upon by majonty 
vot e . In these cases, persons in authority at each 
step of the prescribed communications procedure 
as outlined in Paragraph (b) of this Rule shall be 
notified in writing. Minority report procedures, 
as outlined in Paragraph (c) of this Rule, shall 
be applicable in this procedure as well. 

Statutory Authority G.S. I22C-64: I3IE-67: 
I43B-I47. 



.0209 CONFIDENTIALITY 

(a) Committee members shall have access to 
the records of cUents only upon written consent 
of the chent parent ef guardian or legally re- 
sponsible person as specified in APS.M 45-4 aft4 
10 NCAC 18D .0215 "Confidentiality Rules", 
division publication APSM 45-1. This docu- 
ment is available for inspection in each state fa- 
cility or in the Publications OtTice of the division. 
This right of access is granted so that the com- 
mittees may perform their duties of overseeing 
and monitoring the action of the state facility. 

(b) Committee members shall treat the client 
record as confidential information as specified in 
10 NCAC4*©.Wa*r 18D .0124. 

Statutory Authority G.S. l22C-53(a): I22C-64; 
I3IE-67: I43B-I47. 

.0210 LIMITATIONS ON REPRESENTATION 

In order for a professional to be a member of a 
human rights advisory committee he/she must 
agree not to accept a client of the state facihty as 
a private client for remuneration for professional 
services on the client's behalf during the mem- 
ber's term. If a professional, while a member of 
the committee, accepts such a chent, then he/she 
becomes disquahfied to ser\'e on the committee. 

Statutory Authority G.S. I22C-64; I3IE-67; 
I43B-I47. 

.021 1 STATE FACILITY RESPONSIBILITY 

(a) The state facility director shall provide 
necessary clerical and support services to the hu- 
man rights advisory committee. 

(b) The state facihty director shaU provide an 
orientation to the state facihty for new members 
of the committee at the chairperson's request. 

(c) The state facility director shall assure that 
the facihty's Staff Development Services shall 
implement the division's annual plan of training 
for human nghts advisor\' committee members. 

(d) The state facility director shall be responsi- 
ble for the reimbursement of mileage expenses for 
members of the committee who request financial 
assistance to attend regularly scheduled meetings. 

Statutory Authority G.S. 122C-64; I3IE-67; 
I43B-I47. 

.0212 DIVISION RESPONSIBILITY 

(a) The division director shall ser\'e as the point 
of contact between the committees and the sec- 
retary. 

(b) The division's training office, in conjunc- 
tion with the Go\emor's Ad\'ocacy Council for 
Persons with Disabilities (GACPD), shall de- 



NORTH CAROLINA REGISTER 



899 



PROPOSED RULES 



vclop an annual plan of training for human rights 
ad\'isorv' committee members. 

{h} (£2 The division director shall CMjordinato 
trainmg aR4 provide collaboration opportunities 
for each state facility human rights advisory 
committee and shall assure an opportunity for 
committee chairpersons to meet at least annually. 

(d) The division director shall provide written 
onentation matcnals for all new members. aH4 
Written traimng materials shall cover at a mmi- 
mum the structure and role of the division; the 
role of state facility human rights advisory com- 
mittees; state statutes; and rules codified in the 
North Carolina Administrative Code regarding 
human rights and related areas of concern. 

fe^ 44w divi ji ion director shall dovolop a written 
policy a«4 procedur e concerning t4^ roimburoo 
ment Bi mileage expenoer r fof members who w- 
que '. t financial at .'. i ' jtanco k> attend regularly 
scheduled meetinuG. 



Statutory Authoritv G.S. 
1 43 B- 1 47. 



I22C-64; I3IE-67; 



SKCTION .0300 - INFORMING CLIENTS AND 
STATK FACILITY EMPLOYEES OF RIGHTS 

.0301 INFORMING CLIENTS OF RIGHTS 

fft) Fach client ba* t4+e riglit t» b«» informed ef 
his her nglits *t » chent t4 At» facility. 

ft4 (aj f he state facihty director shall assure that 
all chents and legally responsible persons are in- 
formed of the client's rights at the time of ad- 
mission or not more than 24 hours after 
admission (with the exceptions specifically pro- 
vided for in Paragraph fe^ (b) of this Rule). The 
state facility shall develop a policy which in- 
cludes, but is not limited to, the following: 

(1) specifying who is responsible for informing 
the chent; 

(2) providing a written copy of rights to chents 
who can read and explaining the written 
materials risihts to all chents; 

(3) obtaining documentation documenting in 

the client record that rights have been ex- 
plained to the chent; 

(4) posting copies of rights and the person or 
olTicc to contact for information regarding 
rights in e ach client living area; areas ac- 
cessible to the client. 

(5) descnbmg the role of the human rights 
advisoPt' committee and internal client 
advocate and how to utilize their services; 
and 

(6) infonning the parent &f guardian legally 
responsible person that they may request 
notification alter an>' occurrence of the 
use of an emergency procedure as speci- 



fied in 10 NCAC 14J .0203, .0204 and 

.0205. 
(e^ (b) If the chent cannot be informed of 
his/her rights within 24 hours after admission 
because of his/her condition or if the parent ef 
guardian legally responsible person cannot be 
notified within 24 hours after admission, then 
this exception and any alternative means of im- 
plementing this right shall be documented. 
However, the state facihty may delay notifying 
parents aft4 guardians the legally responsible 
person of chent's rights for up to 72 hours when 
necessary for week-end admissions. 



Statutory A uthority 
I43B-I47. 



G.S. I22C-5I; I3IE-67; 



.0302 INFORMING STATE FACILITY 
EMPLOYEES 

The state facihty director shall assure that all 
staff state facility employees are informed of the 
rights of chents and shall develop a pohcy which 
includes but is not hmited to the following: 

(1) specifying who is responsible for informing 
new and continuing staff; existing state fa- 
cility employees; 

(2) distributing written copies of chent rights 
as specified m .-Vrticle 3 of Chapter 122C to 
all staff state facility employees and obtain- 
ing documentation that state facility em- 
ployees have read and understand the chent 
nghts; 

(3) obtaining documentation that quahfied 
professionals on staff have read and under- 
stand chent rights as specified in G.S. 
122 55.1 through 122 55. M Article 3 of 
Chapter 122C of the N.C. General Statutes 
and regulations as specified in 10 NCAC 
14G through 14J; 

(4) estabhshing a procedure V i 'ith documonta 
tieft *«• train, re^'iov »f update staff for 
training or updating state facility employees' 
awareness of client nghts as specified in Ar- 
ticle 3 of Chapter 122C of the N.C. General 
Statutes, 10 NCAC 14G, 14H. 141 and 14J, 
and through state facility pohcy at least an- 
nually and whenever changes occur. Such 
education shaU be documented; and 

(5) identifying individuals who can be con- 
tacted to answer questions regarding rights. 

Statutory Authority G.S. J22C-5J; I3IE-67; 
I43B-I47. 

.0303 NOTIFICATION ON GLARDI.\NSHIP 

(a) The client shall be informed of the different 
aspects and pohcies concerning guardianship 
when the use of guardianship becomes an issue. 



900 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(b) The client shall be permitted to participate 
as fully as possible in all decisions that will affect 
him/her. State facility staff employees shall seek 
to preserve for the incompetent adult client the 
opportunity to exercise those rights that are 
within his/her comprehension as specified in G.S. 
35-1.6(4) and (5). 

(c) The state facility director shall assure that 
incompetency proceedings are pursued for adult 
cUents when the treatment team determines that 
the client is unable to make or communicate 
important decisions about his/her life. To the 
extent possible, statutory' proceedings for limited 
guardianship rather than full guardianship should 
be pursued. 



Staluton' Authority G.S. 
1 43 B- 147. 



I22C-5I: I3IE-67; 



(3) 



(4) 
(5) 



.0.304 INFORMING CLIENTS OF POLICIES 

The state facility director shall assure that each 
client » and the legally responsible person .uc 
informed of the following: 

(1) the state facility policy on reimbursement 
or criminal liability for personal or property 
damage caused by the cUent to the state fa- 
cility, other cUcnts, employees, visitors or 
their property; 

(2) the state facility policy on charges for 
treatment or habilitation services as consist- 
ent with 10 NCAC 141 .0310; 

the state facihty rules and regulations that 
the client is expected to foUow and possible 
penalties for violations; 
the state faciUty grievance procedure; ttR4 
the state facility's authority to initiate, when 
appropnate, involuntary commitment pro- 
cedures for a voluntary client; and 
(6) the state facility policv on search and sei- 
zure. 

Statutory Authority G.S. 122C-5I; I3IE-67; 
1 43 B- 1 47. 

.0305 RESE.\RCH 

The state facility director shall assure that all 
research involving human subjects is conducted 
in accordance with accepted research practices 
and is reviewed according to -W NCAG \AQ 
Soction rmmr 10 NCAC 14C .0800. Research 
which that places human subjects at risk, except 
minimal nsk research, shall be subject to the 
Department of Health and Human Services pol- 
icy for the protection of human research subjects 
as codified in 45 C.F.R. 46. 

Statutory Authority G.S. 122C-SI; I22C-57; 
13IE-67; 1 43 B- 147. 



.0306 CONSENT TO PARTICIPATE IN 
RESEARCH 

(a) The state facility director shall assure that 
all clients who participate in research, except 
minimal risk research, elect to do so after having 
received a full explanation of the purpose, po- 
tential benefits and risks of participation. 

(b) Informed written consent shall be obtained 
from the client or legally responsible person for 
each new research project. Whenever a client is 
adjudicated incompetent and is a ward of the 
state, or whenever a client adjudicated incompe- 
tent or a minor client objects to participation in 
a research project, the client shall not participate 
in the research project. Consent shall be docu- 
mented in the client record and shall include: 

(1) client or legally responsible person's signa- 
ture and date; 

brief description of the research project; 
length of consent, which shall not exceed 
six months without renewal; 

notification that consent may be with- 
drawn at any time without penalty; 

explanation of any potential risks and 
plans to reduce or address such risks; 
signature and title of the investigator and 
date; 

disclosure of any established alternative 
procedures that would probably achieve 
similar therapeutic goals as those antic- 
ipated through the research; and 

a provision that the client or legally re- 
sponsible person wUl be given notification 
of any significant changes in the research 
procedures which directly affect the client. 

Statutory Authority G.S. 122C-5I; 122C-57; 
I3IE-67: I43B-I47. 

SUBCHAPTER I4H - CIVIL AND LEGAL 
RIGHTS 

SECTION .0100 - GENERAL RIGHTS 

.0101 RIGHT TO LIVE AS NORMALLY AS 
POSSIBLE (REPEALED) 

Statutory Authority G.S. I22C-5I; I31E-67; 
I43B-I47. 

.0102 COMPETENCY OF ADLLT CLIENTS 

fa^ FJach adult client h** 4h» right to oxorcir i O 
basic human rights a« spociliod m G.S. 132 55.1 
aR4 122 55.7. 

rTTT t^TlL'l I ItULlIC \Jlid 1 L 1 dUlI 1!.' t IIC I IC^Il TTT l_' Jl.l_ 1 

f . .^ ft ri 1 1 . "■ « 1 .- 1 1 J-< l"T T. t ■.-• » 1 J-t I J-1 t- 1- ' 

a* specifi e d wt Gr^ 122 55.2(c). 



(2) 
(3) 

(4) 

(5) 

(6) 

(7) 



(8) 



NORTH CAROLINA REGISTER 



901 



PROPOSED RULES 



(€^ I'uch udult eWtrt rt ali times r e tains the 
ntiht k+ i. L ' »J aft4 rt ' coiv e seak ' d moil, »ft4 to 
contact k>gt4 coun t.e l aft4 private physicians as 
npocific'd ift Gr^ 122 55.2(a) aft4 according te 
procedur e s specified ift W NCAC 4414 .0201 afl4 
4^302 »ft4 4-y- .ftWHr 

fd^ I' . ach adult client retains additional righto 
a*i specified m Qr^ 122 55.2(b) unless these 
rights Ufa limited ef re ' . i trictod » writing »» a 
standard fonn i» A^ client's treatment ef habili 
tation plan fof a period Hot- te- o.xcood 40 days 
unless renevi i ed ift writing eft a standard form. 

Fach adult client has the right to b£ considered 
IcizalK competent unless adjudicated incompetent 
under the provisions of Chapter 35A of the 
(jeneraJ Statutes; and each incompetent adult 
client has the right to be restored to legal com- 
petencN as specified m Chapter 35A of the Gen- 
eral Statutes. 

Stamorv Aulhority G.S. I22C-5I; I3IE-67; 
I43B-I47. 

.0103 BASrC RIGHTS 

fa^ liach minor client ha» the right te oxerciso 
basic human nglits a» specified tft G.S. 122 55.13. 

fb^ Fach minor client hȴ at- ali reasonabl e 
times communicate w+th- those has'ing leeal 



tody iH¥^ \sith legal counsel aft4 private specialists 
e4 his h e r choice ef his h e r l e gal custc^dian *+f 
guardian's choice, at- his her twrfi expen ^' e a?^ 
specified ift G.S. 122 55.1 1(a) aft4 accordum tft 
proc e dur e s specified ift +» > . 'C,\C WH .424H-'aft4 

fe^ F'ach minor client retains additional rights 
a*, sp e cified ift G.S. 122 55.1 ' l(b) unless these 
nglits afe limited e* restncted m- ' i vritinu ift a el*- 
ent's treatment plan fe* a penod H»t- te- exceed 
^ days unless renev t ed h* wnting eft a standard 
form. 

(a) Fach client in a state facility has the right 
to exercise basic human nghts as specitied m G.S. 
122C-51, 122C-52(c), 122C- 54(c), 122C-57, 



22C-5S, 122C-61,and 122C-62. 



(b) Onh' those rights specihed m G.S. 
122C-62(b) and 122C-62(d) may be restncted bv 
the state facility. Such restnctions shall be m 
accordance with G.S. 122C-62(e). 



Statutory Authoritv G.S. I22C-51; 122C-52; 
I22C-57: I22C-58: I22C-6I: I22C-62: I3IE-67: 
1 43 B- 1 47. 

.0104 KKI IGIOLS RIGHTS 

(a) Each client has the right to participate in 
religious worship as specified in G.S. 
122' 55.2(b)(7) aft4 122 55. M(b)( ' 1). 

122C-62(b)(7) and 122C-62(d)(7). 



(b) Participation shall be voluntary, but wor- 
ship opportunities, services, religious education 
programs, pastoral counseling, or pastoral 
visitation shall be permitted accessible for those 
who choose to participate. 

(c) Clients shall be permitted to participate in 
religious services in the community unless other- 
wise limited in the treatment or habilitation plan, 
as specified » 44) NCAC 44J- Mi^ 

(d) Suitable space for rehgious worship shall 
be made available by the state facility. 

Statutory Authority G.S. I22C-62; I31E-67; 

I43B-I47. 

SECTION .0200 - LEGAL RIGHTS 

.0201 ACCESS TO LEGAL SERVICES 

(a) All adult clients sbaH- retain have the right 
to contact and consult with legal counsel of their 
choice according to the provisions of G.S. 
122 55.2(a)(2). AH- minor clients bave th« rigkt 
tft initiate aft4 r e c e iv e communioation aft4 con 
ftftlt- with- legal counsel ©f their choice ©f their 
parent's ef legal custodian's choice according te- 
the provisions »f Gr^ 122 55.1 l(aK2). 
122C-62(a)(2) and 122C-62(c)(2). 

(b) Information regarding the availability of 
legal services shall be given to all chents and shall 
be posted eft bull e tm boards i» in areas accessible 
to all clients, h' . mg areas. Information pro\'ided 
by legal assistance programs concerning the 
availabiLity of their services for the indigent cli- 
ents shall be posted in areas accessible to all cli- 
ents, ar e as. Each state facility director shall 
ensure that all state facility staff employees are 
informed of the availability of legal services for 
clients in a manner deemed appropnate by the 
state facility director, including the right of clients 
to communicate and consult with attorneys. 

f64 Scheduling appointments through the facil 
it¥ director » ft©t a requirement fef chents te 
meet with aft attorney ef ' ■ ice s'ersa. However, 
clients aft4 attorneys are requested te oohodulo 
appointments through the facility dir e ctor, ft is 
recommended that appointments h% scheduled 
H^ only te ensur e tfwtt the chont is available at 
the proper time without disruption ef the client's 
treatment ef habUitation plan ef meals, bftt afse 
te- allow the facihty te maintain security where 
needed. 

(4-^ (c) Each state facility director shall designate 
locations where chents and attorneys may con- 
duct their- mtcr.iews in pri\'acy. 

Statutory Authoritv G.S. I22C-5I; I22C-58; 
122C-62: I22C-1I1: 131E-67: I43B-147. 



902 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



.0202 NONPROFIT LEGAL SERVICES 
ORGAM/.ATIONS 

Bach state facility director shall designate an 
interview room where clients may, at regularly 
scheduled hours, privately communicate and 
consult with an attorney employed by or affil- 
iated with a nonprofit legal services organization. 
During these scheduled hours, any client who 
desires to consult with an attorney may do so 
without an appointment. Upon written request 
by a nonprofit legal services organization, such 
an interview room shall be made available in 
each building occupied by clients. The frequency 
of making such an interview room available and 
the hours it shall be available shall be at the dis- 
cretion of the state facility director; however, 
such interview room shall be available at least 
twice per month. Information regarding the time 
and date when such legal services will be avail- 
able and the specific location of such interview 
room shall be posted e«- bulletin boardo in ail 
client living areas accessible to the client in the 
buildings involved. 

Statuloiy Authority G.S. I22C-5I: 122C-58; 
I22C-62; I22C-III: I3IE-67: I43B-I47. 

.0203 STATE FACILITY GRIEVANCE 
PROCEDLRE AND REPORTS 

(a) Each state facility shall ha\e a written pro- 
cedure to process clients' formal grievances in a 
fair, timely, and impartial manner. The grievance 
procedure shall specify that it is not intended to 
cover informal verbal expressions of dissatisfac- 
tion or discontent which can be resolved in- 
formally. 

(b) The grievance procedure shall include the 
following: 

(1) a provision stating that grievances may be 
filed on behalf of a client by: 

(A) the client; 

(B) the parent Bf poroon »f agency having 
logal cuL i tody legally responsible person of 
a minor client or incompetent adult client; 

(€) the guardian Bi aft incompolent cliLint; 
fO) (C) the internal cUcnt advocate; or 
ffe) (D) :my other competent adult, includ- 
ing St all", a state facility employee, who has 
been designated by the client and given 
written consent to bring a grievance on 
his/her behalf; 

(2) a provision requiring grievances to be filed 
in writing and a copy sent to the internal 
client advocate; 

(3) a provision specifying the progressive steps 
of the grievance process and steff mem 
befs state facility employees by position 
responsible for hearing the grievance at 



each step. Such provision shall state 
whether the state facility's human rights 
advisory committee shall be included in 
the progression. (I he absence of such a 
provision shaU in no way prevent clients 
from presenting their concerns to the hu- 
man rights advisory committee at any 
time. Such a provision would simply in- 
clude it in the routine progression.) The 
progression should begin at a level closest 
to the cbcnt such as the client's primary 
qualifi e d responsible professional and, if 
unresolved, progress through the organ- 
izational structure of the state facility. 
The treatment team and the state facility 
director shall be included in the 
progression; 

(4) a provision specifying the number of days 
for action to be taken at each level; 

(5) a provision specifying required written 
documentation for the grievance includ- 
ing, at a minimum, a description of the 
grievance, all parties involved, dates and 
actions taken at each step and specifying 
staff state facility employees responsible 
for such documentation and where in ad- 
ministrative files the record of documen- 
tation shall be tiled; and 

(4^ a provii i ion ijlating whether tt>e facility's 
human nght;: . oummitteo nhaU be included 
ift t4*e progroosion ( Ih e aboonco ef ouch a 
provinion shall i» He way prevent clients 
from presenting their ooncomo t» the h»- 
man riglits committee at- afty time; ouch a 
provision would simply include it- i» tfee 
routine progrosoion); aft4 
f?) (6} a provision stating that the state facility 
director shall make a final decision re- 
garding the grievance before the cUent 
may request review of the decision by the 
division according to Rule .0204 of this 
Section. 
(c) AU linal decisions relative to grievances filed 
on behalf of clients shall be reviewed by the hu- 
man riglits advisoPt' committee whenever such 
review is in accordance with 10 NCAC 14G 
.0209. 



fe-^ (d) The state facility director shall submit a 
written report at least armually to the human 
rights advisory committee and internal client ad- 
vocates which documents the number, nature, 
and resolution of grievances at the state facility 
for the previous year. 

Statutoty Authority G.S. I3IE-67; 143B-I47. 

.0204 DIVISION DIRECTOR'S REVIEW 
OF GRIEVANCES 



NORTH CAROLINA REGISTER 



903 



PROPOSED RULES 



(a) If a client [or client's representative as 
specified m Rule .0203(b)(r) (JQl of this Section) 
is dissatisfied with the state facility director's de- 
cision in a grievance, the client (or client's repre- 
sentative) may request a re\iew of the state 
facility director's decision by the division. 

(b) Ihc client (or client's representative) shall 
submit a written request for review of the deci- 
sion to the appropriate deputy director of the di- 
vision (as indicated by the state facihty director). 
The request siiall indicate: 

(1) a dcscnption of the grievance; 

(2) action taken by the state facility director; 
and 

(3) preferred action of the chent. 

(c) 1 he deputy director receiving the request 
for review of the decision shall notify the division 
director, division's assistant director for quality 
assurance and any other deputy or assistant di- 
rector whose responsibihties overlap in the area 
of the grievance. 

(d) The deputy director receiving the request 
shall collect inlbrmation on the issue and make 
a determination in consultation with any other 
deputy or assistant director involved. 

(e) rhc deputy director shall make a recom- 
mendation to the division director within 10 
working da\ s from the date of the receipt of the 
request. 

{() The di\ision director, after appropriate 
consultation, shall issue a written decision to the 
requesting party within 20 working days from the 
original date of the receipt of the request by the 
deputy director. 

(g) The division director's decision shall be 
considered the final administrative review to be 
undertaken by the di\'ision. 

Staiuton Authority G.S. I3IE-67; I43B-147. 

.0205 DKP.VRTMKNT RK\ lEW OF GRIEVANCE 

(a) The client |or client s reprcsentatise d e &ig 
nut e d as specified in Rule .0203(b)(1) (D) of this 
Section] may pursue further review by the de- 
partment by submitting a written request to the 
secretary. Such written request should indicate: 

(1) a description of the grievance; 

(2) action taken by the state facility director 
and division director: and 

(3) preferred action of the client. afi4 

(44 a deadlin e (allowing fef a4- k»a^4- 4-^ worldng 
dav !. ) afior \shich fok4 udinini ' .Urali' . L' w- 
' l iew Vr4i t>t» con '' idorod L'.xhaU '. teJ. 

(b) The secret an' shall conduct a rc\'icw of the 
gne\;mce and submit his decision in wnling to 
the client or client s reprcscntati\e at least 30 davs 
foUowini; receipt of the request. The secretary's 
review shall be the tinal administrative review. 



Statutory Authority G.S. I3IE-67; I43B-I47. 

.0206 ACCESS TO INTERNAL CLIENT 
ADVOCATE 

The state facility director shall assure each client 
access to a an internal client advocate in accord- 
ance with G.S. 122C-62(a)(3)and 122C-62(c)(3). 

Statutory Authority G.S. I22C-62; I3IE-67; 
1 43 B- 147. 

.0207 CLIENT ADVOCATE ACCESS TO 
CONFIDENTIAL INFORMATION 

(a) Chent advocate access to client r e cords k 
govomod W W NCAC 1 8 D.0325 &f A« 
confidentiality rcgulationo (divi&ion pubUoation 
j\PSM 15 1). confidential information shall be 
in accordance with G.S. 122C-53(e). (f) and (g). 

(b) WTienever a minor client is admitted to a 
regional ps\chiatric hospital which provides edu- 
cational services, the chent advocate may have 
access to the educational records in accordance 
with G.S. 122C-53(a). The state facility director 
shall estabhsh policies and procedures for ob- 
taining consent upon admission of the minor 
chent to the state facilitv, which allows the chent 
advocate access to the educational records. 



Statuton- Authority G.S. 122C-53; I22C-62; 
I31E-67: I43B-I0: I43B-147. 

.0208 DE.ATIIS AND AUTOPSIES 

(a) The state facUity director shall adopt a 
written pohcy, available to the chent upon re- 
quest, specifying procedures to be taken upon the 
death of a chent which shall provide for: 

(1) a physician s certification of the death as 
soon as possible; 

(2) making reasonable efforts to locate the 
chent s next of kin; 

(3) notification of the state faciUty director 
and the internal chent advocate; 

(4) notification of the County Medical Ex- 
aminer when the attending physician or 
state facihty director (at the time of the 
chent 's death) determines that the death 
falls under the jurisdiction of the County 
Medical Examiner as specified in G.S. 
130A-383 and 130A-389; aft4 W >:CAC 
44 .0200; and documentation of the Med- 
ical E.xaminer's report in the chent record; 
and 

(5) disposition of the body when no next of 
kin or interested individuals can be located 
and no funeral arrangements have been 
made, including notification of the Com- 



904 



i\ORTH CAROLINA REGISTER 



PROPOSED RULES 



mission of Anatomy as specified in G.S. 
130A-4I5, 

(b) A competent client, or incompetent adult 
client or minor client through his/her legal 
guardian, Bf minor client through hio/hor parent 
»f poroon ©F agency having legai custody legally 
responsible person, has the right to prearrange 
his/her funeral at no expense to the state. 

(c) No autopsy shall be performed on the body 
of a deceased client unless permission has been 
given for the autopsy by the appropriate person 
as specified in G.S. 130A-398 or unless such 
autopsy is otherwise required or permitted by law 
as specified in G.S. 130A-389, 130A-399 or 
130A-400. 

Statutory Authority G.S. I30A-383; I30A-389; 
I30A-39S: 130A-4I5; I3IE-67: I43B-I47. 

SECTION .0300 - LABOR RIGHTS 

.0301 EMPLOYMENT CONDITIONS 

(a) Each cUent ha* t4ie right te- rocoivo com 
ponoation fop who performs work porform o 4 
which is of economic value to the state facility 
shall receive compensation for such work. 

(b) -fh^ A state facility may allow the client to 
work for the facility only under the following 
conditions: 

(1) if the work is part of the client's individual 
treatment or habilitation plan; 

(2) if the work is performed voluntarily; 

(3) if the client is paid wages commensurate 
with the economic value of the work on 
the open market (except as specifically 
explained in Rule .0302 of this Section); 
and 

(4) if the work project complies with local, 
state and federal laws and regulations. 



Statutory Authority G.S. 
14 3 B- 147. 



I22C-5I: I3IE-67; 



.0302 VOLUNT.XRY NON-COMPENSATED 
WORK 

The state facility may establish a policy allowing 
clients, upon their request, to do voluntary non- 
compensated work. The policy shall: 

(1) provide for protecting the client from abuse 
or exploitation; 

(2) provide for the work to be time limited and 
part of the client's treatment or habihtation 
plan; 

(3) provide that voluntary work performed by 
clients consists of tasks appropriate to the 
age or developmental level of the client; 

(4) provide for review by the guardian legally 
responsible person of an incompetent adult 



or minor client or internal client advocate in 
all other cases of client volunteer work be- 
fore the work is begun; and 
(5) prohibit substitution of voluntary non- 
compensated work for other more appro- 
priate treatment or habilitation 
opportunities. 



Statutory Authority G.S. 
1438-147. 



I22C-5I; I3IE-67; 



SECTION .0400 - NON-DISCRIMINATION 

.0401 TITLE VI CIVIL RIGHTS ACT 1964 

The state facility director shall assure that the 
services of the state facility are provided in com- 
phance with the requirements specified in Title 
VI of the Civil Rights Act of 1964 and 45 C.F.R. 
80 regarding the prohibition of discrimination 
based on race, color, national origin, sex, or 
handicap. 



Statutory Authority G.S. 
143B-147. 



I22C-51; 131E-67; 



.0402 DHR DIRECTIVE - INTERPRETER 
SERVICES 

The state facility director shall assure that the 
services of the state facility are provided in com- 
pliance with the requirements specified in the 
Department of Human Resources Directive, 
Subject: Op e rationo, Provision of Interpreter 
Services for the Deaf, Number 1 81, 37, Effective 
Date: June 1, W^ 1987, estabhshing the pro- 
vision of interpreter services for the deaf and 
hearing impaired. 



Statutory Authority G.S. 
1438-10; J 438- 147. 



I22C-5I; 13IE-67; 



.0403 STATE AND FEDERAL REGULATIONS 

The state facility director shall assure that the 
services of the state facility are provided in com- 
pliance with all applicable state and federal stat- 
utes and regulations regarding 
non-discrimination, including but not limited to 
discrimination against a handicapped person as 
specified in G.S. 168-1 through 168-23, G.S. 
168 A and Section 504 of the Rehabilitation Act 
(29 L'.S.C). 



Statutory Authority 
1438-147. 



G.S. 122C-51; 131E-67; 



SUBCHAPTER 141 - DIGNITY AND RESPECT 

SECTION .0100 - SAFE ENVIRONMENT 
.0101 PROTECTION FROM HARM 



NORTH CAROLINA REGISTER 



905 



PROPOSED RULES 



(a) Fach clit ' iit ha* Ae Ftgkt te fee (fee State fa- 
cility employees and volunteers at a state facility 
shall protect clients from harm, abuse, neglect 
and exploitation in accordance with G.S. 
122C-66. 

(b) State facility employees shall not subject a 
client to any sort of punishment, neglect, or in- 
dignity or inflict physical or mental abuse upon 
any client including, but not limited to, striking, 
burning, cutting, teasing, taunting, jerking, push- 
ing, tripping or baiting a client. 

(c) State facility employees, visitors and clients 
shall not engage in any typo el s e xual acti' i ity 
\v\\\\ a offenses relating to another client as spec- 
ified in G.S. 122C-65. 

(d) State facility employees shall use only that 
degree of force necessary to repel or secure a vi- 
olent and aggressive client. The degree of force 
that is necessary depends upon the individual 
characteristics of the client (such as age, size and 
physical and mental health) and the degree of 
aggressiveness displayed by the client. The state 
facility director may establish policies on the use 
of force and specific techniques. State facility 
employees using specific physical intervention 
techmques shall be trained in their use. 

(e) State facilit\- employees shall not borrow 
money from a cUent or a client s farruly or receive 
gratuity except a non monetary gift of nominal 
value from a client. The state facility employee 
shall not seU or buy goods or services to or from 
a client except through established state facility 
policy. The state facility shall provide safeguards 
for protecting the client from this type of exploi- 
tation and abuse. 

(f) State facility employees shall exercise all due 
precaution to protect each client from ph\sical 
or mental abuse by other clients. 

(g) The state facility director shall establish 
policies to protect the client from exploitation by 
other clients by discouraging the loaning or bor- 
rowing of money and possessions between clients 
and by discouraging the seUing and buying of 
goods or services between clients. 

Statuion- Authority G.S. I22C-65; I22C-66; 
122C-67: lilE-6'^: 1433- 147. 

.0102 CORPOR.\L PLMSHMENT 

Corporal punishment is prohibited, as specified 
in G.S. 122 55.1. Tfei* t»e »f corporal punich 
mont fe»r omployiJ i .": . ¥41i be conridorod abur . e aft4 
invof . tiealL'd a* - - . uoh a* sp e cifi e d » Rulo .0103 »f 
Ow^ Section. 122C-5q. 

Slatutoiy Authority G.S. 122C-59; I3IE-67; 
1438- 1 47. 



(2) 



.0103 RKPORTING ABLSE: NEGLECT OR 
EXPLOITATION 

(a) The state facility director shall develop a 
written policy specifying procedures for reporting 
and investigating all cases of alleged or suspected 
abuse, neglect or exploitation occurring when the 
cUent is under the supervision of the state facility. 
The policy shall be in accordance with G.S. 
122C-66 and shall include at least the following 
provisions: 

(1) specifications of the progressive steps in 
the reportmg and mvestigation process for 
all cases of alleged or suspected abuse, 
neglect or exploitation, staff positions re- 
sponsible for investigation, and time peri- 
ods to be observed for each step; 
a requirement for immediate intervention 
by any state facility employee witnessing 
abuse, neglect or exploitation; 
f4f (3] a system of immediate reporting of any 
suspected abuse, neglect or exploitation 
which includes but is not limited to the 
internal client advocate and appropriate 
etaff state facility employees and pro- 
visions for confidential reportmg; 
f^ (4] the arrangement for immediate medical 
evaluation where major physical injury is 
involved or suspected; 
(4) (5) the designation of a s4aff person state 
facility employee or position to conduct a 
preUminary mvestigation, including the 
review of written reports by all state facil- 
ity employees involved; 
{p-^ [6] in the event that a complete investi- 
gation is indicated, the notification of the 
client advocate, Ae human rights com 
mittee. state facility director, the legally 
responsible person parent fef person »f 
agency having legal custody of a minor or 
client), afi4 guardian &f a» incompetent 
adult client, and the internal client advo- 



cate^ The human nghts advisor,' com- 
mittee may be notified that there is a 
complete investigation indicated: however, 
human rights advisory committee in- 
vohcment shall be in accordance with 10 
NCAC 16G .0209. 
f^ (7) a requirement for immediate reporting 
of any alleged or suspected abuse, neglect 
or exploitation whenever there is a rea- 
sonable cause to believe that the client is 
in need of protective services (as defined 
in G.S. Chapter lOSA, Article 6 and G.S. 
Chapter 7A, Article 44) to the county de- 
partment of social services by aftv effi- 
ploy e e the state facility director or 
designee as specified in G.S. Chapter 



906 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(8) 



(9) 



108A, y\rticlc 6 or G.S. Chapter 7A, Arti- 
cle 44; 

a provision to allow an independent in- 
vestigation by the internal cUent advocate 
and human rights committee, when in ac- 
cordance with H) NCAC 14G .0209, re- 
portmg directly to the state facihty 
director; and 



(b) 



a provision to ensure that all state facility 
employees remain aware of the procedures 
and arc aware of their rights and respon- 
sibilities if they are witness to, or aware 
of, or accused of abuse, neglect or exploi- 
tation. 

Cases of suspected abuse, neglect or ex- 
ploitation occurring when the client is not under 
the direct or immediate supervision of the state 
facility shall be reported to the county depart- 
ment of social services b- any state facility em- 
ployee suspecting ll abuse, neglect or 
exploitation as speciiied m G.S. Chapter 108A, 
Article 6 or G.S. Chapter 7A, Article 44. 

Statutory Aulhoritv G.S. 7A, Article 44; J08A, 
Article 6: I22C-5l': 122C-59; I22C-65; I22C-66: 
I22C-67: I3IE-67: 1438-147. 

.0104 SAFE BLILDINGS AND GROUNDS 

(a) Each client ha* tbe nalit to in a stale facility 
shall live and receive care, treatment, or habili- 
tation in a safe and sanitary environment. 

(b) The state facility director shall assure the 
provision of a safe and sanitary environment 
which is in compliance with the sanitation, health 
and environmental safety codes of state and local 
authorities. 

(c) The state facility director shall have specific 
plans and shall develop and enforce policies de- 
signed to keep the state facility in good repair and 
operation in accordance with the needs of health, 
comfort, safety and weU-bcing of the clients. 

Statutory Authority G.S. I22C-51: I3IE-67; 
I43B-I47. 

.0105 MEALS 

(a) Each client has A# right k» in a state faciUtv 
shall receive a balanced and nutritionally ade- 
quate daily diet. 

(b) Dietary services of the state facility shall 
adequately meet the individual dietary needs of 
the client and meet the preferences of the cUent 
to the extent possible. 

(c) The dietary service and dietary ser\'ice per- 
sonnel shall meet local and state codes. 

(d) The state facility dietary ser%'ice shall serve 
at least three meals per day on a schedule which 



approximates a generally accepted morning, 
noon and evening meal. 

(e) Meals should be served attractively. 

(f) Appropriate therapeutic feeding techniques 
shall be used if the client is unable to feed himself 
or herself. 



Statutory Authority G.S. 
I43B-I47. 



I22C-5I; I3IE-67: 



.0106 REPORTING CLIENT INJURIES 

Whenever a minor or incompetent adult client 
experiences a major physical injury, the legally 
responsible person shall be immediately notified. 
Whenever a coiiipetent adult experiences a major 
physical injury, the client's designated next of kin 
may be notified of the injury when such notifi- 
cation is in accordance with G.S. 122C-53(a). 

Statutory Auth >rity G.S. 122C-5I; l22C-53(a); 
I3IE-67: I43B 147. 

SECTION .0200 - ESTHETIC AND HUMANE 
ENVIRONMENT 

.0201 ST.ATE FACILITY ENVIRONMENT 

(a) The state facility director shall assure the 
provision of an esthetic and humane environ- 
ment winch enhances the positive self-image of 
the client and preserves human dignity. This in- 
cludes: 

(1) providing warm and cheerful furnishings; 

(2) providing flexible and humane schedules; 

(3) directing staff state facihty employees to 
address chents in a respectful manner; and 

(4) providing adequate areas accessible to cU- 
ents who wish to smoke tobacco and 
areas for non-smokers as requested. 

(b) The state facihty director should also, to the 
extent possible, make every effort to: 

(1) provide a quiet atmosphere for uninter- 
rupted sleep during scheduled sleeping 
hours; and 

(2) provide areas accessible to the chent for 
personal privacy, for at least limited peri- 
ods of time, unless determined inappro- 
priate by the treatment team. 

Statutory Authority G.S. I22C-5I; I3IE-67; 
143B-147. 

.0202 ACTIVITIES 

(a) Chontn havo a right \» regular phynioal oxer 
6i«e oo' i 'oral timoo a ' ■ ' I 'ook. ¥h« facility chaU pfe- 
vi4e spac e , oupon'if i ion, aft4 oquipmont f»f ouch 
o.sQrcico. Each state facility shall provide space, 
supervision and equipment for client activities 
and exercise in accordance v\ith G.S. 
122C-62(b)(5) and G.S. 122C-62(d)(5). 



NORTH CAROLINA REGISTER 



907 



PROPOSED RULES 



rt*^ 44*e facility director shaU aoQuro t4*« client 
th** nght te t>*» outdciors daily. 

^ [b] The state facility director shall assure that 
clients have reasonable access to entertainment 
equipment in working order such as a television, 
radio, phonograph, and appropriate recreational 
equipment. 

(-d4 fc| .-Vny imposed limitation on the client's 
freedom to exercise his her rights in (a) tlirough 
f&f of this Rule bv the responsible professional 
shall be documented in Ae clic ' nt's individual 
troatmL'nt plan. accordance with G.S. 

122C-^2(c). 

Statuioty Authority G.S. I22C-62: I3IE-67; 
1438- 147. 

.0203 PKRSONAL LI\ ING SPACE 

Each client ba?- a nght te in a state facility may 
suitably decorate his her room, or portion of a 
multi-resident room, with respect to the client's 
choice, normalization principles, and with respect 
for the physical structure. The state facility di- 
rector may establish wntten policies and justi- 
fications which Hmit this riglit for special 
admissions such as medical surgical, forensic, or 
short-term admissions where admission is for less 
than 30 days. 

Statutory .Authority G.S. I22C-5I: I3IE-67; 
143B-I47. 

.0204 HFALTF1: HYGIFNE .AND GROOMING 

(a) The state facility director shall assure each 
client the nght to dignity, privacy and humane 
care in the provision of personal health, hygiene 
and grooming care including, but not limited to: 

(1) individualized bathing schedules to pro- 
mote privacy; 

(2) an opportunity for a shower or tub bath 
daily, or more often as needed; 

(3) the opportunity to shave at least once ev- 
ery two days; 

(4) access to the ser\ices of a barber or a 
beautician on a regular basis; and 

(5) provision of linens and towels, toilet paper 
and soap for all clients and other individ- 
ual personal hygiene articles for indigent 
clients. Such other articles include but are 
not limited to toothpaste, toothbrush, 
sanitary napkins, tampons, shaving cream 
and shaving utensil. 

(b) Bathtubs or showers and toilets which en- 
sure individual pri\acy shall be available. .-Ml 
bathtubs and shower areas shall be divided by 
curtains, doors or partitions. Toilets shall be in 
separate stalls. 



(c) Adequate toilets, lavatory and bath facilities 
equipped for use by clients with mobility 
impairments, shall be available. 



Statutory Authority 
I43B-147. 



G.S. I22C-5I; I3IE-67: 



SECTION .0300 - PRIVACY AND PERSONAL 
FREEDOM 

.0301 COMMUNICATION RIGHTS 

faf The follovring rights te communicato fhsA 
be rotainod by clionto; 

(4-^ A^ adult clionto ohaU hav e at sA timoo tbe 
right to &ond aft4 rocoivo ocolud mail a* 
cp^ecifiod t» Gt^ 122 55.2(a)(1). The fe- 
cility cohodulo shall be pootod a^ to tbe 
collection aft4 distribution »f moil aft4 
paokagos. 

(-3-^ Each minor client shall havo tbe right at 
ali roasonublc times to communicato with 
tbe individual &f agency havmg legal &**&- 

9»i Tbe foUowing righto shaU be r e tained by all- 
adult clients unless restricted i» vrnting ift tbe 
client's tr e atment plan fe* a period He+ to ojicood 
40 days unless renewed m writing: 

{ 1 1 \ 11 '^A^ )1 t .--l.ii.-i t ■- ■- V, ..11 V-> LT .1 fK.i f-I 1-tl-. t tr-t 

\ i- J ' ul Cr^TTTTT <_ in, 1 1 1 J LTl lUU I III T \} 1 1 IV rT^3TT ^^T 

mak e aft4 receive confidential telephone 
eafe a^ specifi e d » Gr^ 122 55.2(b)(1). 
Telephones located ift pri' i ate ar e as shall 
be accessible to clients. 

/ I \ \ 1 I ■-> . 1 I 1 I t .- t-. . . 1 - .-1 t Vi n r-1 ■ 1 t-i t 4 j-i «-/-i^,-n T 'j-i T r« i~« 4- .--V rr- 

\ i— J ~ 1 "" U^J Li J I J 1 ILl f v. I i l^J 1 1 U CV WT I l^^\_ i f KJ T 1 Jl\.\J 1 J 

daily durmg regularly scheduled hours 
V i liich meet tbe requirements »f G.S. 
122 55.2(b)(2). Visiting hours at tbe fe- 
cility shall be posted i» aA clionX living 
areas. 

f3-^ Suitable areas indoors shall be mad e 
a' l' -ailable fef adult clients aft4 visitors to 
vi»44- irft private. Tbe ar e as wher e cli e nts 
Hwy receive visitors may be specified by 
tbe facility director. 

(4| AH adult clients have tbe right to mak e 
visits outsid e »f tbe facility when m tbe 
be^t- intere - }t ©f tbe client unless tbe client 
was committ e d to dotermino his her ea- 
pacity to proceed to tfiai ift a criminal 
proceeding, »f under G.S. Chapt e r 122, 
Article 44 regarding mentally iU cnminals, 
ef unless tbe client wa* committed a* Ae 
result f4 conduct resulting *» his her b e ing 
charged ' . vith a viol e nt cnm e and wa* 
found H**t guilty by reason ef insanity ©f 
incapable »f proceediim, » whjch ea^e 
Gr^ 122 5S.13 f4^aH be followed. 

{4i 1 imited postag e shall be made a' l ailabl e 
to mdiu e nt clients. 



908 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(«) 44w following rights shall be rotainod by att 
minor cli e nts unlosu rootrictod m writing m ft eli- 
ent's treatm e nt plan fof a period net t» oxoood 
60 days unless rone' i S'od m writing: 

f+^ Aj^ minor clients havo th# right to rec e ive 
such assistanc e as needed i» sending aH4 
r e ceiving corruopondonce and ift malting 
telephone eaUs at- their own eKponso. 

f3) AH- minor clients have the right t» receive 
visitors doily, under appropriate super 
vision, during regularly scheduled hours 
|wliich meet the requirements ef G.S. 
122 55.M(b)(6)|, s«eb visitmg ftet te- take 
precedoncQ over school ©f therapies. 

(4^ Suitabl e areas indoors shall be made 
a' i 'ailable fef minor clients a«4 visitors t» 
visit as fi=ee a« possible from disturbanc e 
by other clients. 4^he areas where clients 
may receive visitors fnay be specifled by 
tbe facility director. 

f4-} Limit e d postage shaU be made available 
t» indigent cli e nts. 

(a) In order to ensure the protection of client 
rights specified in G.S. 122C-62(a)( 1) and Ci.S. 
122C-62(d)(2), each state facility shall post the 
state facility schedule for the collection and dis- 
tnbution of mail and packages in areas accessible 
to clients. 1 imited postage shall he made avail- 
able to indigent clients. State facility employees 
shall proyide assistance to clients as needed in 
sending and receiving correspondence. Such 
physical assistance may include writing letters, 
wrapping packages or reading letters to clients 
upon their request. 

(b) Adult clients in state facilities shall have 
access to telephones in private areas in order to 
ensure the protection of the client right specified 
in G.S. 122C-62(h)(r). Access to telephones by 
minor clients in state facilities shall be in accord- 
ance with Cj.S. 122C-62(d)(l). State facility em- 
ployees shall assist adult and minor clients in 
placing calls upon request of the client. 

(c) In order to ensure the protection of client 
nghts specified in G^ 122C-62(b)(2) and G.S. 
122C-62(d)(.'t), each state facility shall post visit- 
ing hours in areas accessible to clients. Ihe state 
facihty director may establish the same visiting 
hours for the entire state facility or different vis- 
iting hours for different client living areas within 
the state facility. Suitable areas indoors shall be 
made available for adult clients and visitors to 
visit in private, and minor clients and visitors to 
visit as free as possible from disturbance by other 
clients. The areas where clients may receive vis- 
itors may be specified by the state facility direc- 
tor. 

(d) Clients being held at a state facility to de- 
termine capacity to proceed to trial pursuant to 



G.S. 15A-1002 may receive visitors as specified 
in OS. 122C-62(b)(2) and OS. 122C-62(d)(3). 
The following limitations shall be imposed in 
accordance with G.S. 122C-62(g); however, no 
limitations shall be imposed on visitations by 
those persons specified in G.S. 122C-62(a)(2), 
la]i3},lcllll(cl[21,and(cX31: 

(1) Each state forensic facility may estabUsh 



a policy limiting visitations by: 

(A) precluding visits for up to the first three 
days; 

(B) imposing a visit duration limit; and 

(C) limiting the number of visitors, as long 
as criteria are estabUshed making such 
hmitations on an individual basis in order 
to promote the health, safety and welfare 
of the clients^ 

(2) The client shall prepare a list of visitors 
whom he/she desires to see. Only those 
visitors specified by the client will be per- 
mitted to visit with the chent. Clients 
shall be informed whenever a visitor ar- 
rives at the state facility who is not on the 
list of visitors designated by the client, and 
the client shall have the option to add the 
visitor to the list. 



All visitors shall present proper identifica- 
tion upon request. 



(4) Visitors, other than the client's immediate 
family, clergyman and attorney, shall be 
approved for visitation by the client's re- 
sponsible professional. 
To ensure that no contraband is carried 
into the unit where the client is located, 



15) 



no purses, handbags or other items capa- 
ble of concealing contraband will be per- 
mitted in the unit and visitors may be 
subject to routine searches, 
(e) Adult clients retain the rights specified in 
G.S. 122C-62(a)(r), (2) and (3) at all rea.sonable 
times. Minor clients retain the riglits specified in 
G.S. 122C-62(c)(l), (2) and (3) at aU reasonable 
times. These rights may not be limited or re- 
stricted. 



(f) Any imposed limitation or restriction on the 
client's freedom to exercise his/her rights as 



specified in G.S 

or G.S. 122C-62(d)(l 



122C-62(b)(l), (2), (.3) and (4) 
(2) and (3) by the re- 



sponsible professional shall be documented in 
accordance with G.S. 122062(e). 



Statutory 
I43B-I47. 



Authority G.S. I22C-62; I3IE-67; 



.0302 PERSONAL CLOTHING 

(a) All clients have the right to retain and wear 
their own clothes as specified in G.S. 
122 55.2(b)(5) and 122 M(b)(3) 122C-62(b)(6) 



NORTH CAROLINA REGISTER 



909 



PROPOSED RULES 



and G.S. 122C-62(d')(6) except when such clothes 
are determined to be inappropriate to the treat- 
ment regimen by the troatmont toam responsible 
professional, and the reason for that determi- 
nation is documented in tfe© cliont'o troatmont 
plan, accordance with G.S. 122C-62(e). 

(b) The state facility director has an obligation 
to supply an adequate allowance of clothing to 
clients whom the state facihty deems indigent and 
who cannot provide their own clothing. Such 
clothing shall be seasonable, of proper size, of the 
character worn by the cUent's peers in the com- 
munity, and in good condition. 

(c) Persona] clothing left by discharged clients 
shall be held for a 30-day period, during which 
time o' l OP/ efforts shall be made to contact the 
client. If the clothing is not claimed by the client 
within 30 days, it shall be handled in accordance 
with state facility policy. 

(d) Clothing provided by the state facility may 
be kept by the client upon discharge from the 
state facility, at the state facility director's dis- 
cretion. 

(e) The state facility director shall make pro- 
vision for the laundering of client clothing. 

Statutoiy Aulhoritv G.S. I22C-62; 131E-67: 
143B-I47. 

.0303 PERSONAL POSSESSIONS 

(a) Aii adult clionto hasg t^ nght te- kocp aft4 
«^* a roajonablo amount e4^ thoix »wft p e rsonal 
pooC ' eaoionc i oxcopt when tfe* poi i bOC i cions afe de- 
tonninjd t& b# dangorouo »f othiinvic . o inappro 
priatQ te- tfe* troatmont rogimon by Ae troatmont 
toam aft4 tfee r e ason fef ttw* dotormination doou 
montod i» t4*i* client's troatmont plan. Client ac- 
cess to personal possessions shall be in 
accordance with G.S. 122C-62(b)(6) and G.S. 
122C-62(d)f6) except uhen the possessions are 
determined to be potentially dangerous articles 
or otherwise inappropriate to the treatment 
regimen bv the responsible professional and the 
reason for the determination is documented in 
accordance with G.S. 122C-62(e). Each state 
facilitv may develop a policy which restncts any 
of the foUowing potentially dangerous articles to 
ensure the safety of clients: scissors, cigarette 
lighters, matches, razors, mirrors, pocket knives, 
switch blades, or products which contain poten- 
tially abusive substances. 

(-b4 Ati' minor clionto havo tbe nght to koop aft4 
«^e a roasonablo amount ei th e ir ewft porsonal 
poosossions under appropriate suporsioion exc e pt 
when the possessions afe dotormmod te- be dan 
gorous ©P othonvis e mappropriat e to the treat 
m e nt rocdmen bv the troatmont toam aft4 the 



roaoon fof tbe dotormination documontod i» tfe» 
client's treatm e nt plan. 
(e) (b) Personal possessions deposited with the 
state facility for safe-keeping shall be made avail- 
able to the client upon request at reasonable in- 
tervals, unless the client is adjudioatod an 
incompetent adult or a minor, in which case 
these items shall be made available to the in- 
competent adult client or minor or guardian ©f 
paront legally responsible person upon request 
by the legally responsible person. These items 
shall be returned to the client or legally respon- 
sible person upon discharge of the client from the 
state facility, except as specified in Rules .0307, 
.0308, or .0309 of this Section. 



Statutory Authority G.S. 122C-62: 
I43B-I47. 



13IE-67: 



.0304 STORAGE AND PROTECTION OF 
CLOTHING AND POSSESSIONS 

(a) The state facility shall make e vopy a con- 
certed effort to protect the chent's personal 
clothing and possessions from theft, damage, de- 
struction, loss, and misplacement. This includes 
but is not limited to the following; 



(1) 



(2) 



(3) 



(4) 



advising the client, upon admission, to 
deposit jewelry and other valuable articles 
with the state facility for safe-keeping; 
providing individual locked storage space 
acoossiblo to the oUont for his/hor the cli- 
ent's own use in accordance with G.S. 
122C-62(b)(10) and G.S. 122C-62(d)(8) 
which will hold a reasonable amount of 
clothing and other personal possessions. 
afi4 Staff assistance shall be available if the 
client is unable due to physical or mental 
inability to manipulate the locking mech- 
anism, except when such storage space is 
determined to be inappropriate to the 
treatment regimen by the responsible 
professional and the reason for that deter- 
mination is documented in accordance 
with G.S. 122C-62(e); 



developing an inventory- of each client's 
clothing and personal possessions upon 
admission and reviewing and updating it 
armually; and 

discretely marking personal clothing items 
and, for clients being provided long term 
care, discretely marking clothing items 
proN'ided by the state facility with the cli- 
ent's name. Clients who elect to launder 
their own clothing shall not be required 
to have clothing marked but shall be in- 
formed that they thereby assume the risk 
of possible loss. 



910 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(b) The state facility director shall establish 
policies and procedures for managing clothing 
and possessions under the state facility's exclusive 
control. 1 he policy shall also outhne procedures 
for determining loss or damage and for deter- 
mining any appropriate replacement or re- 
imbursement in accordanc e with the Rules in 10 
NCAC IF, Section .0400. 



Statutory Authority G.S. I22C-62; I3IE-67; 
1438- 147. 

.0305 SOCI.VL INTER.^CTION 

The state facility shall establish policies to as- 
sure the provision of suitable opportunities for 
the client's social interaction with members of the 
same or opposite sex. e xcept whoro a quolifiod 
profei f cional ha* limited »f ro ' . i triotod theoo »p- 
pcirtunitiof . t» wnting m tb» client's treatm e nt »f 
habilitation plan. 

Statutory Authoritv G.S. I22C-5I: I22C-62; 
I3IE-67; I43B-I47. 

.0306 COMIOKNTI.M.ITY 

State facilitv emplovces shall complv with the 
G.S. 122C-.S"2 through G.S. 122C-56 and t_he 
confidentiality regulutions rules codified in 10 
NCAC 18D and available in tht* "(ronfidentialitv 
Rules' 



divi 



xiblication Al'S.M 45-1. This 



document is available for inspection in each state 
facilitv or in the Publications Office of the divi- 



Statutorv Authoritv G.S. I22C-52; I3IE-67; 
1438-10: J 438-/47. 

.0307 SE.\RCn AND SEIZURE 

(a^ The provif r ionn ©f this Rule shall apply k» 
aU clients m the disision'o faciliti e s e xc e pt chonto 
ift alcoholic rehabilitation centers, which shall be 
governed bv the provisions »f +0 NCAC 17A 
SiU throuoli 4»:;j^ 

(fe> [a] In keeping with 10 NCAC 14G Section 
.0300 which requires all state facihties to have a 
plan for explaining rights to both clients and 
staff, state facilitv employees, state facility staff 
employees shall notify the client and his legally 
responsible person of the pohcy on search and 
seizure including the provisions of tliis Rule and 
Rules .0308 and .0309 of this Section at the time 
of admission. 

fe^ (b} Authorized searches by state facihtv em- 
ployees are as follows: 

(1) State facility employees may search the cli- 
ent and the client's possessions at the time 
of the chent's admission to the state facil- 
ity. At the time of admission, the client 



may place p)ersonal items in a storage area 
which is secure. The state facility em- 
ployees shall record in the personal prop- 
erty rocord inventory the items placed in 
storage which shall be counter-signed by 
the chent. A copy The original of the 
personal property rocord inventory shall 
be maintained by the state facility and a 
copy shall alse be given to the client or 
his legally responsible person. 

(2) State facility employees may search a client 

and the chent's possessions when the cli- 
ent is returning to the state facility from 
an off-campus visit or after the client has 
received visitors, when it is reasonable to 
behcve a client may have items in his/her 
possession that are dangerous, illegal or 
otherwise prohibited by the state facihty. 

(3) State facihty employees may search a chent, 

the chent's possessions or the chent's liv- 
ing area if the state facihty employees have 
good, substantial and rehable cause to 
beheve that the chent has been drinking 
or using drugs or has dangerous stolen 
articles or substances. Situations justify- 
ing such a search may include, but arc not 
necessarily hmited to, the following; 

(A) When drinking, drug abuse or pos- 
session of dangerous articles or substances 
has been witnessed by state facihty em- 
ployees, reported by another chent or an- 
other reliable informant, or is clearly 
indicated by surrounding circumstances; 

(B) VVhen inappropriate changes in the cli- 
ent's behavior are observed or reported, 
such as slurred speech, ataxia, odor of al- 
cohol, and disruptive behaviors, excluding 
expected changes due to prescribed 
psychotropic medication; 

(C) When a breathalyzer test or urine drug 
screen results in a positive reading |A 
breathalyzer test or drug screen will be 
administered by nursing staff when ap- 
propriate as indicated by the circum- 
stances in («>(b) (3) (A) and (B) of this 
Rule or ordered by a licensed physician.]; 
or 

(D) When a stolen item has been witnessed 
by state facility employees, reported by 
another client or other rehable informant 
or is clearly indicated by surrounding cir- 
cumstances and no criminal charges are 
anticipated. 

fd4 {£]_ Scope of Searches. Except as provided 
in Rule .0309 of this Section, the procedures 
outhned m this Rule and Rule .0308 of this Sec- 
tion are intended for internal security, to protect 
the state facihty from civil liability, and to pro- 



NORTH CAROLINA REGISTER 



911 



PROPOSED RULES 



vide an inventor,' of client's personal property, 
and are not intended for purposes of criminal 
prosecution. 

(1) Searches by state facility employees shall 
be conducted only on the state facility 
premises and may include searching a cli- 
ent, a private or semi-private room and 
any surrounding area, closet, bed, chest 
of drawers, ceiling and personal effects of 
the client. 

(2) Searches by state facility employees may 
include state facihty buildings and 
grounds. 

(3) Only physicians may perform body ca%'ity 
searches if it is determined that there is 
probable cause to do so. Such a search 
shaJl be performed in the presence of a 
member of the nursing staff. The physi- 
cian or member of the nursing staff shall 
be of the same sex as the client. 

(e> (d^ Search Procedure 



(1) 



(3) 



til 



.-Ml searches shall be authorized in writing 
b\ the state facility director or steff mom 
t>eF state facility L-mplo\ee m charge of the 
state facility at the time of the incident 
except: 

(A) searches conducted pursuant to Sub- 
paragraphs fef (b] ( 1 ) or (2) of this Rule; 
or 

(B) searches peribrmed when state facility 
employees have a reasonable suspicion 
that a client has in his her possession a 
weapon or instrument making the client 
presently dangerous to himself herself or 
others, and this danger is imminent as to 
render prior written authorization im- 
practicable. Such f ' oarchijc . shall be docu 
nu ' nl e d imm i 3diatoly. 

!) .\t least two state facility employees shall 
be present dunng a search. A An internal 
chent advocate may be present durmg a 
search. Aft A state facility employee of 
the same sex as the client shall be present 
during a search. 

A client affected by a proposed search, 
other than those specified in Subpara- 
graph fe+ (W ( 1 1 and ( 2| of this Rule shall 
be notified before the search is conducted 
and shall be given the opportunity to be 
present during the search. Individual 
storage spaces shall only be searched when 
the client is present unless there is an im- 
mediate danger of personal injurs'. Such 
L . L>archof . shall be documontod. 
Searches conducted in accordance with 



this Rule shall he documented in the cli; 
ent record. 



{^ fe] Disposition of Seized Property 



(1) ff personal property seized in a search in- 
cludes fire-arms or ammunition, the state 
facility employees shall contact the local 
law enforcement agency for advice re- 
garding disposition of the property. The 
state facility director shall notify the ap- 
propriate deputy director regarding dispo- 
sition of the personal property. 

(2) If personal property seized in a search in- 
cludes controlled substances illegally pos- 
sessed (contraband), the substances shall 
be sent to the state facility pharmacy to 
be held for destruction under the super- 
vision of the Department of Justice. 

(3) If personal property seized in a search in- 
cludes any alcoholic beverages, the 
beverages shall be sent to the state facility 
director for proper disposition. 

(4) If personal property seized during a search 
includes prescription drugs in properly la- 
beled containers; over-the-counter 
medications; dangerous items such as 
knives, scissors, razors, or glue; aft4 
grooming aids that contain alcohol; or 
other items prohibited by the state facility, 
such items may be stored and retumed to 
the client at the time of discharge. Such 
stored items shall be listed on the personal 
property record, inventory. A copy of 
the personal property record inventory 
shall ake be given to the client or his le- 
gally responsible person. 

(5) Items belonging to the minor client or 
minor's paront legally responsible person 
which are seized during a search of the 
minor or the minor s possessions, with the 
exception of the items specified in ffi (e) 
(2) of this Rule, shall be given to the paf- 
eftt- legally responsible person if the paront 
he or she so desires. 

f*) (]} Use of the search procedure specified in 
this Rule shall be subject to review by the human 
rights advisory committee. 

Statutory Authoritv G.S. 90-101; I22C-58; 
I22C-62: I3IE-67;'I43B-I47. 

.0308 SE.\RCH OF LMT/W.\RD 

(a) The entire unit/ward or parts of the 
unit, ward, building may be searched by state fa- 
cility employees if there is good, substantial and 
reliable cause to believe that a threatening situ- 
ation exists that may be dangerous to the client(s) 
and or state facility employee(s). At the forsenic 
unit at Dorothea Dix Hospital, routine searches 
may be conducted periodically in accordance 
with the provisions of Paragraphs (b) through (f) 
of this Rule. 



912 



iXORTH CAROLINA REGISTER 



PROPOSED RULES 



(b) I he appropnate unit/ward director or des- 
ignated supervisory- staff on duty shall give writ- 
ten authorization (based on facts of justification 
;uid what they expect to find from the search) for 
a search to be conducted. Written authorization 
will include scope of search. 

(c) Clients affected by a proposed search shall 
be notified at the time of search and shall be 
gi\cn the opportunity to be present during the 
search of the immediate area, unless this is not 
practical due to the dangerousness of the situ- 
ation or because the client is not on the state fa- 
cility premises. Individual locked storage spaces 
shall only be searched when the client is present 
unless there is an immediate danger of personal 
injury. Clients not present when a search is 
conducted shall be informed that a search took 
place when they return to their unit/ward. 

(d) The search must be conducted by no less 
than two stale facility employees. Reasonable 
ctTorts shall be made to notify a an internal client 
advocate prior to the search unless there exists 
an imminent danger which does not permit time 
for such notification. In all cases, a an internal 
client advocate shall be notified of the search. 

(e) When confiscated items can be attributed 
to a particular client, written justification and 
authonzation for the search shall be entered in 
an incident report tiled with the state facility di- 
rector's office. aft4 The search and lindings shall 
be documented in the client record. 

(f) An inventory of cont~iscated items shall be 
made and kept on file with a copy of the inven- 
tory given to the client or his legally responsible 
person if ownership is detemiined. 

Stalutoiy Authority G.S. I22C-5S; I22C-62: 
I3IE-67; I43B-I47. 

.O.MO CLIENT'S PFRSONAL I LNDS 

(a) Where the state facility has been designated 
as representative payee or when the client is a 
Medicaid recipient, provisions Paragraphs (b) 
through (g) of this Rule shall be interpreted in 
accordance with any requirements of the funding 
source. 

(b) 44w facility t i iiall a - jL i ur e* to e ach client tbt* 

C^LU^i^ ^ ^~^ L^^^^^^ --1.-1.1 1 1 f- i\ ^ wi~i -I .' .^ -1 «-t •-. V^ I . ^ .-11 «-»-» /-\ T rr\ .-V T-> i-n r 

1 1 Cfi i~ \.\j i\.\-\- Y ' cttttt tj vtv ct rcTrrrmTTTCTCT l< u 1 1 1 kj i iii\_'iil' t 

vpt hir . hor p e r '. onal po ' : ii.B ^ . f i ion a* |n accordance 
with G.S. 122C-62(b)(8)andG.S. 122C-62(d)(Q), 
the maximum amount of money clients will be 
allowed to ha\e and spend will be individually 
determined by the treatment habilitation team 
or will be detennincd bv each unit in a state fa- 
cility based upon the needs and abilities of the 
client population. Client requests to retain 
money abo\'e the maximum allowable amount 



be 



by 



the 



client 



treatment habilitation team and the decision shall 
be documented in the client record. Any im- 
posed limitation or restriction by the responsible 
professional on ttie client's right to have and 
spend the sum ol money determined to be rea- 
sonable shall be documented in accordance with 
G.S. 122C-62(e). 

(c) The state facility shall develop written pol- 
icies and procedures which: 

(1) Qf i Bur e te allow the client t4*e right to de- 

posit and withdraw money from a per- 
sonal fund account; 

(2) regulate the receipt and distribution of 
funds in personal fund accounts; 

(3) provide for the receipt of deposits in per- 
sonal fund accounts from friends, relatives 
or others and withdrawal by the client; 

(4) provide for the keeping of adequate fi- 
nancial records on all transactions affect- 
ing funds on deposit in personal fund 
accounts; 

(5) provide for the issuance of receipts to 
persons depositing or withdrawing funds; 
and 

(6) provide for a periodic accounting of per- 
sonal fund accounts. 

(d) Wliere the client, due to his/her physical 
or mental condition, is unable to manage his/her 
own funds, the legally responsible person may 
request that the state facility director provide for 
the handlmg of a portion of funds in the personal 
fund account for a personal needs allowance of 
the client. If the state facility director provides 
for the handling of these funds, proper account- 
ing must be maintained for such monies. The 
funds must be kept separate from any operating 
funds of the state facility. 

(e) The state facility may not deduct from a 
personal fund account any amount owed or al- 
leged to be owed to the state facility or aft a state 
facilitv employee or visitor to the state facility or 
other client of the state facility for damages done 
or alleged to have been done by the client to the 
state facility, property of the state facility, state 
facility employee, visitor or other client, unless 
the client or his legally responsible person au- 
thorizes the deduction. 

(f) The state facility may not deduct from a 
personal fund account any amount owed or al- 
leged to be owed to the state facility for treatment 
or habilitation services unless the client or legally 
responsible person authorizes the deduction. 
The state facility may develop a policy for de- 
duction from personal fund accounts for treat- 
ment or habilitation services which provides for 
this authorization by the client or legally respon- 
sible person upon or subsequent to admission of 
the client. 



NORTH CAROLINA REGISTER 



913 



PROh^SLD l.ULES 



(g) Competent adult clients may maintain or 
invest their money in other than personal fund 
accounts at the state facility. This shall include, 
hut not be limited to, investment of funds in ui- 
terest bearing accounts. 

Statutory^ Authority G.S. 122C-5I; I22C-58; 
I3IE-67: 143B-I47. 

SLBCMAPTFR I4J - TRE.MMENT OR 
HABIl.lT.VTION RIGHTS 

SECTION .0100 - RIGHT TO TREATMENT OR 
HABILITATION 

.0101 APPROPRIATE E\ ALLATION .\ND 
TREATMENT OR HABILIT.\TION 

(a) Each client except day clients shall receive 
a prompt and comprehensive physical and brief 
mental status examination, including laboratop,' 
e%aluation where appropriate, within 24 hours 
after admission to the state facility. Comf"- 
hensive psychological or de\'elopmental evalu- 
ations shall be performed when needed, as 
determined by the responsible professional 
and or treatment habilitation team. The type 
and dates of all examinations shall be docu- 
mented in the client record. There must be a 
physical examination of the client before ordering 
drugf . medication except in an emergency. 

(b) 1 ach client ka* A# right te rt ' cjivc appro 
pnat e troatmont 6>f hubilitation. t*ft4 t» hu' i L* »» 
iiidi' i idual vrntton tr e utnunt e+ habilitation plan 
st^ spL ' cifiL ' d m <r*SrT 122 55.5 aft4 122 55.6. In 
addition to the treatment rights specified in G.S. 
122C-57(a). all handicapped clients have a nght 
to habilitation and rehabilitation as specified in 
G.S. 16S-S. 

(c) Each client Iwts tlw riglu to shaU receive 
e\'aluation and treatment »f habilitation m th* 
l i^ a ' Jt ro ' . ' trictivL' cnvironmL^nt vrhich includos: ac- 
cordance with G_S_ 122C -57(b). G.S. 122C-60 

G.S. 122C-61. 



and 



I'valuation and 



treatment habilitation shaU be pro\ided in the 
least restricti\'e cn\ironment. 

(-4-^ freedom from unnL'CL'ii; ' ar> ' e* oxcoooii i O 
medication a* ppocifiod m -W > i CAC WP 
. 1 )600; aft4 
f3^ frocdom from phyoical rootraint aft4 »©- 
lation tfeat- i** aet- abc ' olutoly noc i jaC ' ary ' . 

Statutory Authority G.S. I22C-5I: I22C-57: 
I22C-60; I22C-6I; I22C-21I; 122C-22I; 
I22C-231; I22C-24I: 122C-266; I22C-285: 
U/E-6': I4SB-I4^. 

.0102 MEDICAL AND DENTAL CARE 

(a) The state facility director shall assure access 
to prompt, adequate and necessar)' medical and 



dental care and treatment to the client for phys- 
ical and mental ailments and injuries and for the 
prevention of illness or disability as specified in 
G.S. 122C-61(1). "Necessary" may be deter- 
mined m hght of the client's length of stay and 
condition. Short term clients shall be apprised 
of other medical and dental conditions and in- 
formed of appropriate medical and dental care. 

(b) All medical and dental care and treatment 
shall be consistent with accepted standards of 
medical and dental practice. The medical care 
shall be performed under appropriate supervision 
of licensed physicians and the dental care shall 
be performed under appropriate supenision of 
licensed dentists. 

(c) Each client shall receive physical and dental 
examinations at least annuaUv. 



(d) 
(1) 



(2) 



(3) 



In cases of medical emergency or necessity: 
if the necessary equipment or expertise is 
not a\'ailable at the state facility, the at- 
tending physician shall arrange treatment 
at an appropriate medical facility; 
if the client is at an unreasonable distance 
from his her home facility, he or she shall 
be taken to a nearer appropriate hospital 
or clinic: and 

if (d)( 1) or (2j of this Rule occur, the state 
facility director shall assure that ti*e lugaUy 
roGponC ' iblo perr . on i^ notifiod. those per- 
sons specified m G S. 122C-206(e) are 
notified. 



Statutory- Authority G.S. I22C-37; 122C-6I; 
J22C-266; JSIE-d^: J43B-J4:'. 

.0103 INDIMDL AI.IZED TRE.\TMENT OR 
HABILITATION PL.\N 

(a) Wh* individual written troatmont »f habili 
tation pkft chaU b<* formulatod within ^ days 
after admic i L i ion te- tfee facility W qualifiod pfe- 
fosoionak i as opocifiod h* G.S. 122 55.6, afi4 The 
state facility shall preside qualified professionals 
to formulate and super%ise the implementation 
of the treatment habilitation plan in accordance 
with G.S. 122C-5^(a). 

(b) Each client ha* the right aft4 shall be en- 
couraged and helped to attend the treatment 

habilitation team meeting and to actively and 
meaninglully participate in the formulation of 
hisher treatment or habilitation plan. The paf- 
&jrt legall\' responsible person of a minor cU e nt 
afi4 the guardian »t' a» or incompetent adult cli- 
ent shall also hav e a right be encouraged to at- 
tend. The amount of participation by the client 
parent, Bf guardian and or legallv responsible 
person shall be documented m the client record. 
B*e client right to participate may W rootricted 
h^ the treatm e nt t e am aft4 documontod ift the 



914 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



record. The internal client advocate, with per- each state facility or in the Publications Office of 



mission of the clin w 
person, shall be 



his legally responsible 
allowed to attend the 



the division. 



treatment habilitation team meeting(s). 

(c) I:ach client has the right te- may, upon re- 
quest, have an in-house review of his/her indi- 
vidual treatment or habilitation plan and/or te 
request the opinion of another person at no cost 
to the state. 

(d) Haoh The client's has tbe right te hav e 
hishor treatment or habilitation plan shall be re- 
viewed at least quarterly by the treatment /habil- 
itation team. 

(e) Wlicn dif . chargo is onticipatod, A discharge 
planning plan shall be included vpt the troutmont 
plan, formulated iri accordance with Rule .0106 
of this Section. 

(f) Upon request, a copy of the client's treat- 
ment or habUitation plan or an interpretive letter 
shall be furnished to the guardian legally respon- 
sible person of an incompetent adult client or aft4 
te- the parent legally responsible person of a mi- 
nor client except for minor clients in alcohol or 
drug rehabilitation programs as specified in 42 
C.F.R. ^ Part 2 or when minors are rccci\ing 
treatment upon their own consent in accordance 
with G.S. 'Jn-21..\ 

(g) The treatment 

form the client of the availability 



habilitation team shall iiv 
of his her 



treatment habilitatuni plan and shall pro\ide the 
competent adult client with a copy of his/her 
treatment/ »f habilitation plan upon request by 
the client when filed in accordance with G.S. 
122C-53fc). 44*e tr e atment team r . hall remind 
the cli e nt ©f thts right after the formulation ef 
e ach treatment Bf habilitation plan. 

(hi Aftv impu ^. ed limitation e«- the client 'o 
freedom tt» e x e rcis e hi»;her right [ . shall be e.xplic 
itiy documented m the client's individual treat 
mest pkft as f . pooifiod » 44^ NCAC +4H 4H4)3 

Statutoiy Authority G.S. I22C-5I; 122C-53; 
I22C-57: I22C-6I; I22C-62; I3IE-67; MSB- 147. 

.0104 CONSULTATION WITH PRIVATE 
PROFESSIONALS (REPEALED) 

Statuton Authohtv G.S. J22C-62; /3/E-67; 
1 43 B- 147. 

.0105 TRANSFER 

The state facility director shall follow the pro- 
cedures specified in -t-O NCAC 4-4€ .0106 through 
r!H\& G_S_ 122C-206 and 'Transfer of Clients 
Between State l-'acilities". division publication 
APSM 45-1 when transferring clients. The divi- 
sion publication is available for inspection in 



Statutory Authority G.S. 
I43B-I47. 



I22C-206; 13IE-67; 



.0106 DISCHARGE 

(a) >\Tien a state facility discharges a client, 
each client oxoopt roapito cliontfi shall have a 
written individualLi'.od post inotitutionol treat 
mont ef habilitation discharge plan as specified 
in G.S. 122 55.6. 122C-6I(2) unless the client: 

(1) is receiving respite services; 

(2) escapes or breaches the conditions of a 
conditional release; 

(3) is unanticipatedly discharged by the court 
following district court hearing; or 

(4) is immediately discharged upon request of 
the client or legally responsible person. 

(b) The post inr . titutional tr e atment ef habiU 
tation discharge plan shall: 



(1) 
(2) 



(3) 



W 



be formulated by qualified professionals; 
inform the chcnt of where and how to re- 
ceive treatment or habilitation services in 
the community. 

identify continuing treatment or habili- 
tation needs, and address issues such as 
food, housing, and employment: and 
be provided t© the client, guardian ef a» 
incompetent client a«4 parent ei a minor 
client e.scept as limited m state »f federal 
statutes regarding oonfidentiaUty; aB4 
{4^ (4) involve the appropriate area program, 
unless refused by the legally responsibl e 
person, except m those instances ' i >'horo 
the appropriate afea program has been 
designated as a single portal afea i» ae- 
cordanoe with G.S. 122 35.36 m which 
ease the procedures described m G.S. 
122 7.1, 122 8.1, 122 35. '13, 122 58.13, 
aft4 122 71.1 shall apply, with consent 
of the client or his legally responsible per- 
son or in accordance with G.S. 



122C-55(a) or G.S. 122C-63. 
(c) When the client is unexpectedly discharged 
by the court in hcanng subsequent to the initial 
hearing, the client's discharge plan shall contain 
at least the following: 

(1) address and phone number of the agency 
in the community where folloyy-up ser- 
vices can be provided, includmg name of 
contact person in Department of Social 
Services if food and housing are issues; 

(2) current medications, if applicable; and 

(3) recommendations for contmued care in 
anticipated problem areas. 

fe) [d] With the exception of the region;d hos- 
pital director who shall follow the provisions of 



NORTH CAROLINA REGISTER 



915 



PROPOSED RULES 



10 NCAC 15A .0113, the state facility director in 
each of the other state facilities shall establish 
written poUcics and procedures to ensure that 
ovary reasonable cfloits w arc made to assist the 
client in obtaining needed services in the com 
munity upon discharge or placement. The policy 
shall include the designation of qualified profes- 
sional staff to assist chcnts in establishing contact 
with the appropriate area program and furnishing 
information to the area program with the client 
or Icaallv responsible person's consent or as 
BpociriL'd m pcnnitted by G.S. 133 8.1(c), (4^aB4 
(*^ 122C-55(a). 

Siatuton' Auihohtv G.S. I22C-55; I22C-6I; 
122C-I32: I3IE-67; I43B-I47. 

.0107 CONSENT 

(a) Consents required in Sections .0200, .0300 
and .0400 in this Subchapter shall be obtained in 
writing or \erbally over the telephone. 

(b) Written consent of the client or his/her le- 
gally responsible person shall be obtained when- 
ever possible. Information which is necessary to 
adequately inform the client shall be documented 
in the client record and shall mclude the follow- 
ing: 

(1) Name of the procedure or treatment and 
its purpose expressed in laymen's terms; 

(2) Evidence that the benefits, risks, possible 
complications and possible alternative 
methods of treatment have been explained 
to the client or his/her legally responsible 
person; 

(3) Notification that the consent may be 
withdrawn at any time without reprisal; 

(4) Specific length of time for which consent 
is \aLid; 

(5) WTicn anesthesia is indicated, permission 
to administer a specified type of anes- 
thesia; 

(6) Permission to perform the procedure or 
treatment; 

(7) WTien applicable, authorization for the 
examination ;md disposal of any tissue 
and;or body parts that may be removed; 

(8) Signature of the client or his/her legally 
responsible person on written authori- 
zations. 

(c) Whenever written consent cannot be ob- 
tained in a timely manner, verbal (telephone) 
consent may be obtained from the legally re- 
sponsible person. The legally responsible person 
shall be asked to sign a written authorization and 
return it to the state facility but the treatment or 
procedure may be administered in accordance 
with the verbal consent. Verbal consent shall be 
witnessed by two staff members and documented 



in the client record. The client record shall also 
include documentation specifying the reason(s) 
why written consent could not be obtained. 

Statutory Authority G.S. I22C-5I; I22C-57; 
I3IE-67; I43B-I47. 

SFXTION .0200 - PROTECTIONS REGARDING 
CERTAIN PROCEDLRES 

.0201 PROHIBITED PROCEDURES 

(«) ¥h« foUowing procoduroo shall Ret b» uood: 
f4^ oontingont ttse »f painful body contact; 

f3) subotanooo adminiotorod te induoo painful 
bodily rL > aotiono. -f^m dees Ret- includ e 
i\ntabu&o. 
fb) Facility steff shall Ret- perform SRy 
psyohoGurgory, including lobotomiuo. 

(a) Each state facility shall develop policies 
relative to prohibited interventions. Such poli- 
cies shaU specifv: 

Q} those interventions which have been pro- 



hibited bv statute or rule which shall in- 
clude: 



(A) any intervention which would be con- 
sidered corporal punishment under G.S. 
122C-5q; 

(B) the contingent use of painful body 
contact; 

(C) substances adnunistered to induce 



painful bodUy 
/Vntabusc; 



reactions exclusive of 



(D) electric shock (excluding medically ad- 
ministered electroconvTilsJN'e therapy); 

(E) insulin shock; and 

(F) psychosurgery. 

(2) those inter\'entions specified in this Sub- 
chapter determined by the state facility 
director to be unacceptable for use in the 
state facility, 
(b) In addition to the procedures prohibited in 
Paragraph (a) of this Rule, the state facility di- 
rector shall specify other procedures which shall 
be prohibited. 

Statutory Authority G.S. I22C-5I; J22C-57; 
I22C-59; I3IE-67: I43B-I47. 

.0202 ELECTROCONVULSIVE THERAPY 

(a) The treatment /habilitation team may re- 
commend the use of electroconvTilsi\e therapy. 

(*> (b) Before electroconvulsive therapy can be 
utilized two licensed physicians, one of whom 
shall be clinically privileged to perform 
electroconvulsi\e therapy, shall approve a written 
plan, which includes indication of need, specific 
goals to be achieved, methods for measuring 



916 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



treatment efficacy, and indications for discontin- 
uation of treatment. In addition, 
electroconvulsive therapy shall not be adminis- 
tered to any client under age 18 unless, prior to 
the treatment, two independent psychiatric con- 
sultants with training or exp>erience in the treat- 
ment of adolescents have examined the client, 
consulted with the responsible state facility psy- 
chiatrist and have written and signed reports 
which document concurrence with the use of 
such treatment. For clients under the age of 13, 
such rc\icws shall be conducted by child psychi- 
atrists. 

(fe^ (c| The tr e atm e nt team internal client adv o- 
cate shall be informed ©f at the time of the deci- 
sion to utilize electroconvulsive therapy 
whenever the client requests such notification or 
when minor clients or adults adjudicated incom- 
petent obiect to the use of electrocon\"ulsive 
therapy. 

fe-)- Ul| riectroeonNulsne therapy shall not be 
initiated w ithout the prior written consent ef tbe 
l e uallv roj' . pon '. iblo pori . on. in accordance with 
GS.'\22C-51({). 

(4+ (_e| If the adult client is determined to be de 
facto incompetent by the treatment habilitation 
team and is determined to need electroconMilsive 
therapy, legal guardianship procedures shall be 
initiated and consent requirements of paragraph 
fe-)- (d| of this Rule shall be met. U »«■ urgent 
UL ' ed L ' xii ' ti ' . pros i ' jionii »f G.S. U)Si\ l()^ prosid 
me emergency protective sor . icoo fof adults may 
be ui i ed. 

(e^ (f} All electroconvulsive therapy shall be ad- 
ministered in accordance with generally accepted 
medical practice and shall be documented in the 
client record. 

(-f^ (£2 The state facility director shall maintain 
a statistical record of the use of electroconxTilsive 
therapy wliich shall include, but not be limited 
to, the number of treatments by client, unit or 
like grouping, responsible physician, and client 
characteristics. The statistical record shall be 
made available to the division director on a 
monthly basis. 

Slaiutorv Authohiv G.S. I22C-5I: I22C-56; 
I22C-57: ISIE-fj": I43B-I47. 

.0203 GENERAL POLICIES REGAROING 
INTERNENTION PROCEDURES 

f»^ Ihi; . Rule gosemr . U^ emergency wee ef 
f . eclu '. ion aft4 meclmnie<il re i' truint m- tl*e regional 
ho ' - ' pitiilr . . AW oth e r otate osvnod aft4 operated 
facilitie - j - jhall complv with tlte proviL ^ ioni . t>f Ruli3 
m!^ trf Ott^ Subchapt e r. 

ftH 44*t» (*i«* t4 r . eclu '. ion »f m e chanical restraint 
shrtU be limited te thooe imitanceo ' ■ ' i horo there » 



imminent danger »f injur . ' to- self »f others e* 
danger »f subotantial property damage ef ceriouo 
dioruption »f the therapeutic environment ' . shioh 
would infringe eft the rights ef other clients. 

(«) Seclusion ef mechanical restraint shali He4- 
be employed a« punislimont »f fof the eewveft- 
ienco ©f staff ef used i» a manner that causes 

nirm ax iiniiiin nn'"''H""il ni''.f nmf nrt tx^ «-*'^'" * r^ t K^ 

client. 

(4) ?^ facility director shall \\a\o written pel- 
jeiee aft4 procedures that go' i -em the h«* »f se- 
olusion aft4 mechanical restraint which include 
the following: 

f4^ proc e dures fof documenting the emor 
gonoy es^ asy intervention which ee- 
ourred te include, b«t ftet be limited t»T 
(A^ the rationale fof the t»e »f restraint ef 
seclusion which addresses the madequaoy 
ef less restrictive inten^ention techniques; 
f4^ documentation that the client was eft- 
gaging m behavior that created imniinent 

U LI 1 1 J_\. I U I LI 11 UI T tTT L^ U ^^r l^T^^CT"^ LT CTTTrRSCT 

»f substantial property damage ©f serious 
disruption »t the therapeutic environment 
t© the e xtent that it would mfringe ©» the 
ri gilts ©f other clients; 

fG+ notation ©f the frequency, intensity. aft4 
duration ©t the behasior aH4 afty precipi 
tating circumstances contnbuting t© the 
onset ©t the behai i ior; 

fO^ description »f the seclusion ©f restraint 
procedure a«4 the date a«4 hour ©f its 

(E) signature aft4 title ©f the employee Fe- 
pponsible fof the wve ©f the procedures; 

Q) procedures fof the notification ef others 
t© include; 
(Al those t© be notified as soon as possibl e 
t© include: 
(44 the treatment team, ©f its designee, 

aft e r e ach »se ©f seclusion ©* restraint ; 
(«-^ a designee ©f the facihty director; »fi4 
fi«-^ the client ads ocate m accordance 
with the provisions ©f -W >.CAC ISD 

f©4 the parent ©f a minor client ©f guardian 

©f aft incompetent client »hen they have 

r e qu e-. t e d such notification. 

fe) The foUov i ing requirements shall be foi- 

lowed when orders afe given fo* the ase ©f me- 

chanical restraint ©f seclusion: 

f4-)- 4h» asc e rtain that the procedur e is justified, 
a physician shall conduct a clinical assess 
ment ©f the cli e nt befor e ssnting aft order 
fof the »se ©f restramt ©f seclusion. 
(-3-^ A ssntt e n order from a physician shaU be 
required fof the «se ©f restraint. 



NORTH CAROLINA REGISTER 



917 



PROPOSED RULES 



(4^ A V i ntton ordor from a phyoician ohaU h& 
requir e d fr>f At? Hse t»f oooluoion fof longer 
Attft efw hour. 

f4f U'ntten ord e rs fof A# «*» ef rootraint *** 
soclui i ion f i hall bi* timL' limitod set- te wt- 
cood 24 l^ourLi. 

(4) 44*t» wnttL ' n approval ef Ae director ef 
L-linical t . enic e s and or hi* e* bef d e sign ee 
&br41 t>^ required ' . ' . hen restraint ef docIu 
»«« » utilised f»f longer than 34 hours. 

(4^ Standing orders (PRN) shall Het- be «se4 
te authorij'.e tbe «^e ©f restraint ef soclu 
sion. 

(^ I'nder tbt* foIlo' . vLng conditions, restraint 
»f seclusion msy be employed without a 
' . s'ritt e n ord e r from a physician: 
(A) tbe ' ■ vritten ordor fe+ restraint e* see^-^- 
sieft- i* gisen by a qualifi e d professional 
' I ' . 'ho has oxpenenc e aft4 training » tbe 
proper «^e ei tbe procedure fof which tbe 
order i^ V i ntten: 
f©) tbe qualified professional writing the 
order ba^ obsenod aft4 assessed the client 
before ' . voting the ord e r: aft4 
fG> the ' . vntten order e^f tbe physician wh» 
i* responsibl e fof the chent's medical eafe 
i* obtain e d within Het more than eight 
hours after initial employment ^ the i=e- 
straint t*f seclusion. 
ff+ While the client t^ » seclusion ef mechan 
jeai restramt the foUo' . vmg precautions shall be 
follo' . v e d: 

(44 Periodic obsenation 84 a client m seclu 

I.- t r~\ t-i -i f\ .\ r.-\. f T-- 1 < jT t ■- t-i ' . 1 1 .■ t -^ -^ 1 1 *- '• t I . 1 '» ■ ♦ ,"H -.n-i - 

^' i U 1 1 cTTTTT I \,^.'l I UH 1 1 ^'1 lUll l_'1_'(.'LJl LI I 1 1^ U L' I k. I \, 1 T 

44 minutes, ef more often ati necessar; .' . to 
assur e safety ef the client. i\ppropnate 
attention shall be paid te- the provision »f 
regular meals, bathing. aft4 the ttse e4 the 
toUet. Such obsep . ation a«4 attention 
shall be documented i» the client s record. 

f3) PrC ' lsion shall be made fof humane, se- 
e«fe aft4 safe conditions » seclusion fe- 
cUities such as adequate ' . entilation, light. 
ae4 a room temperatur e consistent w-rth 
the test ef the facility. 

(4^ Wlien restraint is used m the absence 64 
seclusion as4 the chent may be subject t» 
injuP i ". a staff memb e r shall remain pros 
eftt with the client continuously. 
fe4 R e sie' i vs aftd- r e ports eft the ase t»j^ seclusion 
aR4 mechamcal restraint shall be conducted as 
followo: 

(4^ AH Hses el restraint ef seclusion shall be 
reported daily tev the facility director ef 
his her do ' . ' ignee. 

(r3-)- 44*e facility director 6>f his her design ee 
shall rcie' . v dailv ah »ses ef restraint ef 



Doclusion aft4 inv e stigat e unusual ef pes- 
oibly unwarranted patterns ef utilbtation. 
(4) Bach facility director »f his/her dooignoe 
shall maintain a statistical r e cord ef the 
«se ef seclusion aft4 r e straint which shall 
be available &» a monthly basis te the 
human rights committe e ^Pi4 client advo 

(h^ 44»e facility director shall aosuro by doc 
umentation m the personn e l records that prior 
training i«- the emergency »se »f seclusion aft4 
mochanical restraint procedures has boon pro 
vided te- ah facility staff responsible fof their ase 
»f the rc'iew »f thoir aser Training shall be 
pro' . ided according te- the instructions ef the 4i- 
vision. 

<4) Nothing i» this P>.ulo shall be interpreted te 
prohibit the ese ef voluntary seclusion ef me- 
chanical restraint at the client's request: however, 
the procedures i» fa+ through fh) ef this Ptul e 
shall apply. 

(a) This Rule go\'ems the pohcies and require- 
ments rciiarding the use of the following inter- 
ventions: 



ill 

13} 
iii 

15) 
[61 



seclusion: 
restraint: 

isolation time out; 

exclusionar%' time out for more than 15 
minutes: 



time out for more than one hour; 



Ql 



contingent withdrawal or delay of access 
to personal possessions or goods to which 
the client would ordinarilv be entitled; 
consistent depn\ation of items or cessa- 
tion of an activity which the client is 
scheduled to receive (other than basic ne- 
cessities); and 
(8) overcorrection to which the chent resists, 
(b) The state facility director shall de\'elop 
policies and procedures for those intersentions 
determined to be acceptable for use in the state 
facility. Such pohcies shall include: 

( 1 ) procedures for cnsunng that the compe- 
tent adult client or legally responsible 
person of a minor client or incompetent 
adult cUcnt is informed; 
(A) of the general types of intrusi\e inter- 
ventions that are authorized for use by the 
state facility: and 



(2) 



(B) that the legalh responsible person can 
request notification of each use of an 
intervention as specified m this Rule, in 
addition to those situations required bv 
G.S. 122C-62; 

pro\isions for humane, secure and safe 
conditions in areas used for the inter- 
vention, such as adequate \entilation. 



918 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



light, and a room temperature consistent 
with the rest of the state facihty; 

(3) appropriate attention paid to the need for 
fluid intake and the provision of regular 
meals, bathing, and the use of the toilet. 
Such attention shall be documented in the 
client record; and 

(4) procedures for assuring that when an 
intervention as specified in this Rule has 
been used with a client three or more 
times in a calendar month, the following 
requirements are met: 

(A) A treatment habilitation plan shall be 
developed within ten working days of the 
third intcncntion. The 
treatment habilitation plan shall include, 
but not be limited to: 

(i) indication of need; 

(ii) specific description of problem be- 
havior; 

(iii) specific goals to be achieved and es- 
timated duration of procedures; 

(iv) specilic earlv interventions to prevent 
tension from escalatmg to the point of 
loss of control uhene\'er possible; 

(v) specific proccdurc(s) to be employed; 

(vi) specific methodology of the inter- 
vention: 

(vii) methods for measuring treatment 
efficacy: 

(viii) guidelines for discontinuation of the 
procedure; 

(ix) the accompan\ing positive treatment 
or habilitation methods which shall be 
at least as strong as the negative aspects 
of the plan; and 

(x) specilic limitations on approved uses 
of the mtcrvention per episode, per day 
and requirements for on-site assess- 
ments by the responsible professional. 

(B) hi emergency situations, the 
treatment habilitation team may continue 
to use the intervention until the planned 
intervention is addressed in the 



quarterly, if still in effect, by a designee of 
the state facility director. The designee 
of the state facility director may not be a 

client's 



member 



of 



trcatment/habUitation 



the 
team. 



Reviews 



shall be documented m the client record. 

(F) Treat ment /habilitation plans which in- 
clude these mterventions shall be subject 
to review by the human rights advisory 
committee in compliance with 
confidentiality rules as specified in 10 
NCAC 14G. 

(G) Each treatment /habilitation team shall 
maintain a record of the use of the inter- 
vention Such records or reports shall be 
available to the human rights advisory 
committee and internal client advocate 
within the constraints of _I0 NCAC 18D 
.0215 and G.S. l22C-53(g). 

(H) The state facility director shall follow 
the Right to Refuse Treatment Proce- 
dures as specified in Section .0300 of this 
Subchapter. 

(I) The interventions specified in this Rule 
shall never be the sole treatment modality 
designed to eliminate the target behavior. 
The interventions are to be used consist- 
ently and shall always be accompanied by 
positive treatment or habilitation meth- 
ods. 

(c) Whenever the interventions as specified in 
this Subchapter result in the restriction of a right 
specified in G.S. l22C-62(b) and (d), procedures 
specified in G.S. 122C-62(e) shall be followed. 
Exception to this Rule includes the use of seclu- 
sion, restraint and isolation time out, which is 
regulated in Rule .0204 of this Section. 

(d) The state facility director shall assure by 
documentation in the personnel records that state 
facility employees who authorize interventions 
shall be pnvileged to do so^ and state facihty 
employees who implement interventions shall be 
appropriately trained in the area of such inter- 
ventions, as well as alternative approaches. 

(e) The state facility director shall maintain a 
statistical record that reflects the frequency and 
duration of the individual uses of interventions 



treatment habilitation plan. 
(C) The treatment habilitation team shall 
explain the intervention and the reason for 
the inter\-ention to the client and the le- specified in this Rule. This statistical record shall 



gaily responsible person, if applicable, and 
document such explanation in the client 
record. 

(D) Before implementation of the inter- 
vention, the treatment habilitation team 
shall approve the treatment habilitation 
plan. 

(E) The use of the inter\-cntion shall be re- 
viewed at least monthly by the 

least 



_ least monthly by 

treatment habihtation team and at 



be made available to the human rights advisory 
committee and the division at least quarterly. 

Statutory Authority G.S. I22C-5I: I22C-53; 
I22C-60; I3IE-67:'I43B-I47. 



.0204 SECLUSION: RESTRAINT AND 
ISOLATION TIME OLT 

(a) This Rulo gosoms tk« emerg e ncy ««# »f 
ooclusion aft4 moohanical restraint ift ail otato 



NORTH CAROLINA REGISTER 



919 



PROPOSED RULES 



owned aft4 opuratod facilitioo othtT than rogional 
ho ' jpitals. ?4*e rogional hoopitaJs tihall tomply 
wrtfe Ai* pros'ioions ef Rul e .0203 ef tfes Sub 
chapter. 

^TTy I I IV U -,^J \J1 UV,^' I UIJH/ 1 1 l^I III VT. I lUJ LTl^UT r^^^TTT^H^T 

shall be limited t» those ini ' tanoe - j ' > >horo there i* 
immin e nt danger Bi injury te- setf »f oth e ro e* 
danger &i C f ubctantial property damage. 

(*) Seclusion »f mechanical restraint shall set- 
be employed a* punishment ef fof tbe con' , en 
ience »f staff ©f us e d » a manner that- causes 

ohent. 

1 tJ T TT Cr CTTCTTT 1 lUD 1 ILIVJ. 1 1 IJ ^.^' V-'I xTT^TT^ l_'l I IV I >^"I ' T 

interventions using ^^e clu 'i ion ©f mechanical Fe- 
straint m a 30 day penod &f ii a pattern »f di^ 
ruptive behavior bas de'reloped, the seclusion ef 
restraint shall be considered a level H4 procedure 
aft4 shall be subject to the provisions ©f Rul e 
.0206 ef tb+s Subchapt e r. A treatment plan, as 
specified » Rule .020^. 4>ii-l4. be de^ i eloped ' . vithin 
4-0 v . orlcing days ©f tbe tliird emergency int e r 
vontion. 

fe) ¥be facility dir e ctor shall have written pei- 
ieiee aftd procedures tbat- govern t4*e H*e ©f se- 
clusion aft4 mechanical restraint which include 
tbe follo' i ving: 

f4-^ procedures fof documenting tbe emor 
goncy aft4 ss¥r intenontion which ©6- 
curr e d t© include, btrt »©* be limited te^ 
(rV^ the rationale fef tbe H*e ©f restraint ©f 
seclusion vvhich addresses tbe inadequacy 
©f le** restnctivo mtenention techniques. 
f&^ documentation tbat- the client was ea- 
gaging if* beha' i ior tba* created imminent 
danger ©f injur , te- setf ©f others ©f danger 
©f substantial property damag e ; 

duration ©f tbe behavior aad aftv procipi 
tating circumstances contributing te- the 
onset ©f tbe behavior; 
f©4 description ©f Ae seclusion ©f restraint 
procedure aft4 tbe date aftd hour ©f it* 

(&) signature afl4 title ©f tbe employee Fe- 
sponsible fof tbe (*se ©t^tbe procedure; aftd- 
(4^ procedures fo* the notdication ©f others 
te include 
(A^ those t© be notified a* soon as possible 
after tbe emergency has been controll e d 
t© include: 
ftl the tr e atment team, ©f tts designee. 

after each t*se »t seclusion ©f restraint; 
f»f a designee ©f tbe facility dir e ctor; aft4 
(4ii-^ the client advocate ift accordance 
vrttb tbe provisions ©f 44 NCAC 4*© 
ra^a»7aft4 



fS^ t4^ parent ©f a minor client ©f guardian 
©f a» incompetent client when tbey have 
requested such notification. 
(1^ ¥ke following roquiromento skaU b« iei- 

1\J TT t"\l TT 1 JUII \_TTTJVT U LU V CTt^TTT rOT kllU U L^^ ^^T rT^^~ 

chonioal restraint ©f seclusion: 

(4^ ¥© ascertain tbat tbe procoduro is justified, 
a physician ©f a qualified professional 
designated by tbe facility director shall 
conduct aft ass e ssm e nt ©f tbe client before 
writmg aft order fef tbe »se ©f restraint ©f 
s e clusion. 

f3) A written order from a physician ©f a 
quolrfiod professional shall be required fof 
the ««e ef restraint. 

f^ A written order from a physician ©f qual 
i6e4 professional shall be required fep the 
»*e ©f seclusion fsF longer than ©fte hour. 

f4^ Wntten orders foF tbe «se ©f restramt ©f 
s e clusion shall be time limited aet t©' ex- 
ceed 34 hours. 

f§4 Tbe written approval ©f the facility direc 
t©* ©f his her design oo shall be required 
wh e n r e straint ©f seclusion is utilised fof 
longer than 34 hours. 

f6^ Standmg orders shall H©t be used t© a«- 
thorL'.e tbe ttse ©f restraint ©f seclusion. 
fs4 WTiile tbe client is ift s e clusion ©f m e chan 
ieal restraint tbe following precautions shall be 
followed: 

(-4-^ Periodic observation ef a client ift soclu 
si©ft aft4 restraint shall occur at least every 
44 minutes, ©f more often as necessary, t© 
assure safety ©f t4*e client. Appropriat e 
att e ntion shall be pai4 t© tbe provision ©f 
regular meids, bathing, aft4 tbe Hse ©f tbe 
toilet. Such observation aft4 att e ntion 
shall be docum e nt e d ift tbe client's record. 

(-2^ Provision shall be mad e foF humane, se- 
e«Fe aft4 safe conditions ift seclusion fo- 
cilitios such as ad e quate v e ntilation, hght, 
aft4 a room temperature consist e nt vrith 
tbe Fest ©f tbe facility. 

(-3-^ Wh e n restraint is used ift tbe abs e nc e ©f 
seclusion aftd tbe client may be subj e ct t© 
injupv. a staff" member shall remain pros 
eftt V i ith t4k* client continuously. 
(4H R e vi e ws afi4 reports ©ft the Hse ©f seclusion 
afi4 mechanical restraint sbaii be conducted as 
follo' i vs: 

(4-^ A44 «ses ©f restraint ©f seclusion shall be 
r e port e d daily i» tbe facility director ©f 
his her designee. 

(4^ 44ie facility dir e ctor ©* his her designee 
sbali review daily ali ases ©f restraint ©f 
seclusion afi4 investigate unusual »f pos 
sibly unwarranted patterns ©f utilij;ation. 



920 



SORTH CAROLINA REGISTER 



PROPOSED RULES 



P) Each facility director ef hiu/her design oo 
ohall maintain a statistical record ef tfee 
«*e ef seclusion aft4 restraint ' ■ vhich shall 
fee available e» a monthly basis te the 
human rights committee aft4 client advo 

(4^ The facility diiector shall asouro fey dee- 
um e ntation i» Ae personnel records that- prior 
training ift the emergency Hse ©f seclusion aft4 
mechanical restraint procedur e s ha* boon pfe- 
vided te all facility staff responsibl e fof thetf ««e 
&f the review ©f their Hser Training shall fee 
provided according t& the instructions ef the di- 
vision. 

ft^ Nothing in- this Rule shall fee interpreted t& 
prohibit the ase »f voluntary s e clusion ep me- 
chanical restraint at the cli e nt's request; however, 
the procedures m fa} tlirough ft> &f this Rul e 
shall apply. 

(a) This Rule delineates the procedures to be 
followed for seclusion, restraint and isolation 
time out in addition to the procedures specified 
in Rule .0203 of this Section. 

(b) This Rule governs the use of physical or 
behavioral interventions which are used to ter- 
minate a beha\ior or action in uhich a client is 
in imminent danger of abuse or injury' to self or 
other persons or when substantial property 

or which are used as a 



damage is 
measure of therapeutic treatment, 
ventions include: 
( 1) seclusion; 



Such inter- 



(2) restraint; and 

(3) isolation tune out. 

(c) 1 he use of seclusion, restraint and isolation 
time out shall be limited to those situations 
specified in G.S. I22C-60. which include: 

(1) emergency interventions (planned and 
unplanned); and 

(2) therapeutic treatment as specified in Rule 
.0205 of this Section. 

(d) If detennined to be acceptable for use 
within the state facility, the state facility director 
shall establish written policies and procedures 
that govern the use of seclusion, restraint imd 
isolation time out which shall mclude the fol- 
lowing: 

( 1) process for identifying and pri\ileging state 
facility employees who are authorized to 
use such interventions^ 

(2) proNJsions that a qualified and or respon- 
sible professional shall: 

(A) review the use of the intervention as 



soon as possible but, at least, within one 
hour of the initiation of its use; 
(D) venf\' the madequacy of less restrictive 
intcr\'ention techniques: and 



(C) document in the client record evidence 
of approval or disapproval of continued 
use. 
(3) procedures for documenting the inter- 
vention which occurred to include, but 
not be limited to: 
(A) the rationale for the use of the inter- 
vention which also addresses the inade- 



quacy of less 
techniques; 



restnctive mter\'ention 



(B) notation of the frequency, intensity, and 
duration of the behavior and any precipi- 
tating circumstances contributing to the 
onset of the behavior; 

(C) description of the intervention and the 
date, time and duration of its use; 

(D) estimated amount of additional time 
needed in seclusion, restraint or isolation 
tune out; and 

(E) signature and title of the state facility 
employee responsible for the use of the 
interventiom 

(4) procedures for the notification of others 
to include: 
(A) those to be notified as soon as possible 
but no more than 72 hours after the be- 
havior has been controlled to include: 



(i) the treatment habiiitalion team, or its 
designee, after each use of the inter- 



vention 



(ii) a designee of the state facility director; 
and 

the internal client advocate. 



m ac- 
cordance with the provisions of G.S. 
122C-53(g); and 
(B) notitication in a timely fashion of the 
legally responsible person of a minor ch- 
ent or an incompetent adult chent when 
such notitication has been requested. 

(e) Seclusion, restraint and isolation time out 
shall not be employed as punishment or for the 
convenience of staff or used in a manner that 
causes harm or undue physical or mental dis- 
comfort or pain to the client. 

(f) Whenever a client is in seclusion, restraint 
or isolation time out for more than 24 contin- 
uous hours, the client's rights, as specified in G.S. 
122C-62, are restricted, "["he documentation re- 
quirements in this Rule shall satisfy the require- 
ments specified in Cj.S. 122C-62(e) for restriction 
of rights. 

(g) Whenever seclusion, restraint, or isolation 
time out is used more than three times in a cal- 
endar month, a pattern of behavior has devel- 
oped and future emergencies can be reasonably 
predicted. Therefore, the dangerous behavior 
can no longer be considered unanticipated, and 
emergency procedures shall be addressed as a 



NORTH CAROLINA REGISTER 



921 



PROPOSED RULES 



planned 



intcn'cntion 



in 



the 



treatment habilitation plan. 

(h) In addition to the requirements in this 
Rule, additional safeguards as specified in Rule 
.021 )^ of this Section shall be initiated under the 
following conditions: 



ill 



\\1iene\cr a client exceeds spending 40 
hours, or more than one episode of 24 or 
more continuous hours of his/her time in 
emergency seclusion, restraint or isolation 
time out during a calendar month; or 
(2) Whenever secluMon. restraint or isolation 



intervention for up to one hour. The 
qualified professional shall observe and 
assess the client within one hour after au- 
thorizing the continued use of the inter- 
vention. If the inter\'ention needs to be 
continued for longer than one hour, the 
professional responsible for the client's 
treatment habilitation plan shall be con- 
sulted. 



time out IS 



used 



as a measure ot 



therapeutic treatment as specified in G.S. 
122C-60 and is limited to specific planned 
behavioral intenentions designed for the 
extinction of dangerous, aggressive or un- 
desirable behaviors, 
(i) The written appro\al of the state facility di- 
rector and or his or her designee shall be required 
when seclusion, restraint or isolation time out is 
utili/ed for longer than 24 continuous hours. 



(i) Standing orders or I'RN orders shall not be 
used to authonze the use o 



seclusion, restraint 



or iscijation time out. 
(k) 1 he client shall be removed from seclusion. 



restraint, or isolation time out when he she no 
longer demonstrates the dangerous behavior 



(3) The responsible professional shall author- 
ize the continued use of seclusion, re- 
straint^ or isolation time out for periods 
over one hour. If the responsible profes- 
sional IS not immediately available to 
conduct a clinical assessment of the cHent, 
but after discussion with the qualified 
professional, concurs that the intervention 
is justified for longer than one hour, 
he she mav verbally authonze the contin- 
uation of the intervention until an onsite 
assessment of the client can be made. The 
responsible professional shall conduct an 
assessment of the client and wnte such 
authonzation within 12 hours from the 
time of initial employment of the inter- 
vention, 
(m) While the client is in seclusion, restraint 



which precipitated t 

no case shall the client remain in 



straint or isolation time out longer than an hour 
after gainmg behavioral control unless the client 
is asleep during regularly scheduled sleeping 
hours, ff the client is unable to gain self-control 
within the tune frame specified in the authori- 
zation, a new authonzation must be obtained. 
(1) Whenever seclusion, restraint or isolation 



or isolation time out, the following precautions 
shall be followed: 
in seclusion, re- ( 1 ) Whcne\'er a client is in seclusion or re- 



emergencv situation. In 



straint, penodic observation of the client 
shall occur at^ least every 15 minutes, or 
more oltcn as necessary, to assure the 
safety of the client. Appropriate attention 
shall be paid to the provision of regular 
meals, bathing, and the use of the toilet. 
Such observation and attention shall be 
documented in the client record. 



time out is used on an emergency basis pnor to 

inclusion in the treatment habilitation plan, the (2) NVTienever a client is in isolation time-out 

following procedures shall be followed: 

( 1 ) A state facility employee authorized to 
administer emergency inten.'entions may 



there shall be a state facility employee in 
attendance with no other immediate re- 



employ such procedures for up to 15 
minutes without further authorization. 
(2) A qualified professional who has experi- 
ence and training in the use of seclusion, 
rcstramt. or isolation time out and who 



sponsibilitv than to monitor the client 
who IS placed in isolation time out. There 
shall be continuous observation and 
verbal interaction with the client when 



appropriate to prevent tension from esca- 
lating. Such observation shaU be docu- 
mented in the client record. 



has been privileged to employ such inter- 

ventions may authonze the continued use (3} When restr.unt is used in the absence of 



of such interventions for up to one hour 
from the time of initial employment of the 
intcr\ention. If a qualified professional is 
not immediately available to conduct an 
assessment of the client, but after dis- 
cussion with the state facility employee, 
concurs that the intervention is justified 
for longer than 1 5 minutes, he she shall 
verbalh- authorize the continuation of the 



sion, 



seclusion and the client mav be subject to 
injury-, a state facihty employee shall re- 
main present with the client continuously. 
Reviews and reports on the use of seclu- 
restraint and isolation time out shall be 



conducted as follows 



( 1 ) the stale facility director or his/her 
designee shall re\iew all uses of seclusion, 
restramt and isolation time out in a timeh' 



922 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



fashion and investigate unusual or possi- 
bly unwarranted patterns of utilization. 
(2) each state facility director shall maintain a 
log which includes the following informa- 
tion on each use of restraint, seclusion and 
isolation time out: 



(A) 

mi 



name of the client; 



name of the responsible professional; 
date of each intervention; 
time of each interv^ention; and 
duration of each intervention. 



(o) Nothing in this Rule shall be interpreted to 
prohibit the use of voluntary seclusion, restraint 
or isolation time out at the chent's request; 
however, the procedures in Paragraphs (a) 
through (n) of this Rule shall apply. 

Statutoiy Authority G.S. I22C-5I; 122C-53; 
I22C-60; 131E-67; MSB- 147. 

.0205 PROTECTIVE DEVICES 

(*} ^fth* wse ©f phvoiciil restraint as defin e d i» 
4^ >;CAC 44a M^ (^ ¥rhiei¥ k «*e4 fof lese 
than 4-^ continuous minutoo shall be conducted 
i» aooordanctj svith the follovving pro' i 'ioiono: 
(-1^ Physical restraint shall aet- be omployod 
a* punishment ef fof t4te convonionce ©f 
staff ef used t» a manner that- causes harm 
ef undue physical discomfort e* pain te- 
t4*e client. 
(5i The faoihty director shall assure by doe 
umontation i» Ae personnel records that 
prior training ifi- the emergency wse ©f 
physical r e straint ha* been provided to aU- 
facility staff responsible fof its Hse ©f the 
ros'io' . ' i ' ©f its Hser Training shall be p?©- 
vi4e4 according t© the instructions ©f the 
division. 
(4)- The facility director shall develop written 
policies aft4 proc e dur e s governing the ase 
©f physical restraint fof less than T& con 
tinuous minutes. 
fb) The «se ©f phvsioal restraint as defmed fo 
m NCAC 440 T^Wi (^ whteh is ase4 fof ttt©fe 

LJ ILlll 1 ^' rTTTTTTTTC^ L' 1 1 UJ. L l-'l- <JV^ I lU LH_' I L,'U ITT LH_'^'\J 1 ULU H_^J 

with tl*e following provisions: 

(4^ The use ©f physical restraint m the fe- 
gional hospitals shall be limit e d t© those 
instanc e s wh e r e th e re is immin e nt dang e r 
©f injuP r ^ t© self ©f others ©f danger ©f 
substantial property damage ©f serious 
disruption ©f the th e rap e utic environment 
which vvould infringe ©» the rights ©f 
other clients. 

(^ The tise ©f physical restraint ift ali state 
owned aft4 operated facUities other than 
r e gional hospitals shatt be Umited te- those 
instances whore there is imminent danger 



©f Lnjur)f t© setf ©f oth e rs ©f danger ©f 
substantial property damage. 
(^ Physical restraint shall ft©t be e mployed 
as punishment ©f fof the oonvonionce ©f 

©f undue physical discomfort ©f pain t© 

the ohont. 
(4) The facility dir e ctor shali have written 

poUeieo afi4 procedures that govern tiie 

«se ©f physical restraint v' l 'hioh include the 

following: 
(A} procedur e s fof documenting the e mer 

g e ncy aft4 afty intervention which ©e- 

ourrod t© include, but R©t be hmitod t©4- 

(f) the rationale fof the Hse ©f restraint 
which addresses the inadequacy ©f less 
restrictiv e inton'ention t e cliniquos; 

(ii) documentation tbat the client was 
e ngaging ift behavior that created ii»- 
minont dang e r ©f injury t© setf ©f ©th- 
efSr ©f danger ©f substantial property 
damag e , ©f m the ease ©f the regional 
hospitals, which created danger ©f sefi- 
©«s disruption ©f the therapeutic e nvi 
ronment te- the extent that it would 
infring e ©» the rights ©f oth e r cUonts; 

(iif> notation ©f the frequency, intensity, 
aft4 duration ©f the behavior aft4 any 
precipitating oircumstanceo contributing 
te- the onset ©f the behavior; 

(t¥) de - voription ©f the r e straint procedure 

c^^^^T ^^^^? ^^^^^^ c^^^^T ^^^^^^r ^^r i^^j ^^^^^^ c^^^^x 

(v^ signatur e aftd title ©f the employee 
responsible fof the«se©f the procedur e ; 

T T^ T \- ' ^-^-T-TJTJl \Jlj \\Jt II I\J IIU til IVU.lll.f I r \Jl (_/l 1 IVl \j 

t© include those t© be notifi e d as soon as 
possible after the emergency has been 
controlled t© include: 
(i^ the treatment team, ©f its designee, 

after each ttse ©f restraint; 
fii^ a designe e ©f the facility director; aR4 
(ii*) the client adv^ocate i» accordance 

with the provisions ©f 44 NCAC 4-S© 

(G) procedures fof the notification ©f tbe 
parent ©fa minor client ©f guardian ©f aa 
incompetent client V i lion they have fe- 
quested such notification. 
f§^ 4ft all state owned aft4 operated facilities 
exc e pt the r e gional hospitals, if a ohent 
has ha4 three ©f mor e emergency inter 
ventiono using physical restraint ift a 
30 day p e riod ©f if a pattern ©f disruptive 
behavior has developed, the restraint shall 
be consider e d a l e v e l 444 procedure aft4 
shall be subject t© the provisions ©f Rul e 
.0306 ©f this Subchapter. A treatment 
plan, as specified ift Rul e .0306, shall be 



NORTH CAROLINA REGISTER 



923 



PROPOSED RULES 



dovolopod within -W ^orliing days ef th« 
third L'morgoncy Lntor i 'ontion. 

^^^^ ^^^^^^^^^^^^^^ ^^^^^L ^^^^^^^^^^O ^^*^ ^J^^^ ^^^^^ ^^i T^ 1^ \ 1 r-t t^r% 1 

T T ? 7 1 T.\- T i\J TT VJ HI lU 1 t.T '\TI I J CTTT 1 1 T%J ^r^^7 ^^ j^^^^^o^T^ti 

rt ' straint shall fee conduotod a* folio wg: 
(A^ Att tHies ©f roL ' traint ' jhali b© r e port t » d 
dady te- the tcicility director ef hio hor 
dt'i ' ignee. 
fft^ 4^ facility dirootor t>f hi - j h e r designee 
shall revi e w daily ali ««e* ef rootraint aR4 
investigate unusual »f possibly unwar 
ranted patterns ef utilaation. 
fGf Iiach facility director t»f his her designee 
shall maintain a statistical record ef the 
Bse e4^ restraint V i hich shall be available 
©ft a monthly basis ^ the human rights 
committee aft4 client ad' i ocate. 
f^ 44+e facility director shall assure by doe 
umentation m- Ae personnel records Aat- 
prior training ift tbe e mergency «*« &f 
physical restraint ha* been pro' i ided t© ali 
facility frtrrff responsible fef ite ttse ef Ae 
re' . 'iew ©f ite H^er Training shall be pfe- 
Vi4e4 according to the instructions ef tbe 
di' i ision. 
fe+ Nothing m tbi* Rul e shall be interpreted te 
prohibit tbe t»e »f voluntary physical restraint 
at- the client's request: hov i c'rer. the procedures 
wi (-a4 rtft4 (-b4 »f tbi* Rule shall apply. 

(a) Wlienever protective de\ices are utihzed for 
clients, the state facilit\" shall: 



(1) 



(21 



ensure that the necessit\- for the protccti\-e 
de\'ice has been assessed and the device 
applied bv a person who has been trained 
and clinically privileged in the utilization 
of protecti\e de\ices. 
frequently obser.e the client and pro\ide 
opportunities for toiletrng. exercise, etc. 
as needed. Protecti\e devices which limit 
the client's freedom of movement shall be 
observed at least e\er\ two hours. 
Whenever the client i^ restrained and 
subject to injury' bv another client, a state 
facility employee shall remain present 
with the client continuously. Obser\'a- 
tions and interventions shall be docu- 



mented m the client record. 
(3) document the utilization of protective de- 
vices in the client's nursing care plan, 
when applicable. and 

treatment habihtation plan, 
fb) In addition to the requirements specified in 
Paragraph (a) of this Rule. protecti\e devices 
used for beha\ioral control shall comply with the 
requirements specified in Rule .0203 of this Sec- 
tion. 

Statuton- Authoriiy G.S. I22C-5I: I22C-53; 
I22C-66: 13IE-67: 1438-14''. 



.0206 INTERVENTIONS REQUIRING 
ADDITIONAL SAFEGUARDS 

(a^ L e v e l Hi inton'ontions are tbe most intru 
sive level designed fof tbe prunary purpose ef Fe- 
ducrng tbe incidonoo &f aggrosoi' i 'o ef 
s e lf injurious behavior to a level which wiH- allow 
tbe twe ei less intrusive treatment habUitation 
procedures. Tliese int e n'entiono present a sig- 
nifioant Hsk te tbe chont aft4 inoludo tbe follow 
i»g proc e dur e s: 

{Vf seclusion afi4 mochanioal restraint as Fel^ 
erencod m ft«le .0201 (4) ef tbis S«b- 
chapt e r: 
f3) physical r e straint as r e ferenced m Rul e 

Tftg4» (b)(5) &f tbis Subchapter; 
fi) unpleasant tasting foodstuffo; 
(-4-)' t*se ©f electric shook ( e xcluding medically 

admmjstered e l e ctrocon' i 'ulsi' i e therapy): 
(4^ planned non attention t© specific undosir 
able behaviors ' ■ shen tbe target behavior 
j* health threatening; 
f6^ contingent deprivation ©f aay basic nooos 

sityf 
{p-f contingent application ©f aft¥ noxious 
substances which includ e b«+ are R©t lifft- 

1 1 1- U L \J 1 TT_T I L'^-' , tTCr^T >J1 11\.UL5, \JT LTl_'IU JI III I C^ ^TTTTT 

water: aft4 
fS) afty other potentially physically painful 
procedure ©f stimulus ' i >hich is adminis 
tered t© tbe cli e nt fo* tbe purpose ©f Fe- 
ducing tbe frequency ©f intensity ©f a 
b e hai i ior. 

/ !"< \ A 1 ,-tT ■, 1 I III Tt«-J-t^.-tj^-1l n-ft r- Vl o 1 1 r, ,-n Ji-t.r' V-t n <■ V-t J-i .- j-t 1 ft 

T T_T J T^r 1^ T ^. 1 III L' 1 tJ t V^J LI 1 ^.' U 1 1 LLTT I iV T ^_'I ^^P II I\J L^^IU 

treatment modality f»F tbe e limination ©f targ e t 
beha' i ior. Lov'el H4- procedures shall al' . ' i ays be 
accompanied by positii i 'e tr e atment ©f habili 
tation m e thods i i v-hioh includ e tbe deliberate 
t e aching afi4 r e inforcement ©f behaviors V i hich 

associated with non injurious behaviors such as 
a» e nriched educational aft4 social environment; 
afi4 tbe alteration ©f elimination ©f environ 
mental conditions which afe reliably correlated 
' ■ ' ■ '1th seU mjury. 

fe-^ Pnor t© tbe implementation ©f afty planned 
(ise ©f a level 144 procedure tbe following written 
appro^ ^ 'als aft4 notifications shall be obtained aft4 
documented m tbe client's record: 

f4-) 44*e treatment t e am shall appro' i ' e tbe 

plan. 
(-3-^ Hach client whoso treatment plan mclud e s 
level 444 proc e dures with reasonable fore 
seeable physical consequences shall i=e- 
ceive aft initial medical examination aft4 
periodic planned momtoring by a physi 
cian. 



924 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(^ 44w troatmont toum ohall notify the client 
advocate that- a level W proooduro has 
boon planned fof the client. 

(4) ^fhe treatment team ohall oxplain the level 
H-I- proc e dur e te- the cli e nt aft4 the legally 
responsible porson, '4 applicabl e , aH4 shall 

L.'IlL1TT 11 IV IT lUT »T I IHV-'II l-'i^ll-^ III ^TT CITC nT 

gaily responsible person. If the client &f 
legally rosponoiblo person, if applicable, 
refuses the procedure, the facility director 
shall follow the riglit t» refuse treatment 
procedures as specifi e d i» Rul e .0303 »f 
this Subchapter. 
(4^ 4^ plan shall be reviewed aft4 approved 
by- a review committee doiiignated by the 
facility dir e ctor. At l e ast eoe member 
shall be qualifi e d througli oxperionoo aft4 
training t» utilL; e the plann e d procedure. 

I "HT 1 1 11. I ITt_^_ r 17T II IV T^T^^^T^r ^^^TTll 1 11 1 IL t.' L'i lUll 

be a member »f the client's tr e atment 
team. 
f6^ The treatment plan may be reviewed aft4 

option. 
f?4 -Fhe plan shall be reviewed by the human 
ri gilts committ ee HNitlun the constraints trf 
44) NCAC Ui^ 4iM^ »f the confidentiality 
regulations (dis ision publication jM'SM 
' 15 1). ?4*e committee, by majority ' ■ ote. 
may recomin e nd approval ef disappro' i cil 
»f the plan te- the facility director e* may 
abstain from making a r e comm e ndation. 
If the facility dir e ctor do e s ftet agree with 
the decision ef the committee, the com 

I I 1 1 L I \^\J 1 1 lU T HI ■ l.'V.TJ.l TTTC' I J.' LH^ TTT 1 1 rV cTTtTTTFTTTX 

ift aC ' Cordance with the provisions ef -14) 
NCAC 44a 4)30^ 
f8^ If afty ef the persons ef committoon sp e c 

U' . , . 1 u^ /.. t / I \ I ')\ / ,1 \ / s t i^w i t^\ . aI' f U ■ .- 

11 l^'U III \ 1- I ^ I / , I i_ ^ , \ 1 ^ , I ^' I , rTT 11'^ TTT 1 1 1 1 .1 

Rule d» ftet approve the continu e d Hse 
»f a plann e d procedure, the planned pfe- 
c e dur e shaU be terminated. 44»e facility 
director shall establish aft appeal mech 
anism fof the resolution »f afty di ' , . agree 
ment over the H*.e ef a level III proc e dure. 
I e* ! el III procedures shall be used only 
the treatment team has detennined aft4 
docum e nt e d i» the r e cord the follovsing: 

^11 I 1 ILl I 1111^' t. 1 11^ 1 1 1 TTT CTTZ^TT^rn^r 111 L'^^llH I IIM ,' 1 1 1 11 1 

may result h* injuiy te self e* others. 
that other methods ef treatment ef habil 
itation e mploying less rntrusis e proc e 
duros afe set appropriate; 
the frequency, mtensity a«4 duration ef 
the target b e hasior, aft4 the behavior's 
probable antecedents aft4 oonsoquencos; 



when 



(^ 



^ 



(4^ it is liltely that the l e vel III procedure wiH 
enabl e the client te- step the target b e hav 
iefr 
(e) ?^ written treatment Bf habilitation phH* 
including level III procedur e s shaU include btrt 
H©t be limited te^ 

(4^ indication ef need; 

duration ef proc e dur e s; 
(^ exact procedur e s; 

(4) methods JW measuring treatment e fficacy; 
f§) guidelines fef discontinuation ef the pfe- 

codures; aft4 
{€^ the accompanying pooitis'o treatment ef 
habilitation methods. 
{pf 44te »6e ef seclusion aft4 restraint ift the re- 
gional hospitals shall follow the requirements 
sp e cifi e d i» Rule .0203 ef this Subchapter aft4 
shall Ret be considered a l e vel III procedure. la 
all other stat e owned aft4 operated facilities, the 
plamied use ef s e clusion e* restraint shall be tft 
accordance with the provisions ef this Rule. 

fg^ 44>e tr e atm e nt team shall decignato a staff 
member te maintain accurate aft4 up to date 
written records e» the application ef the level III 
procedure aft4 accompanying positive prooo 
dures. Fheso records shall includ e at a minimum 
the tbllowini': 



m 



f3) 



(^ 



data which reflect the frequency, intensity 
aft4 duration with which the targeted be- 
havior occurs (scientific sampling proc e 
dures afe acceptable); 
data which reflect the frequency, intensity 
aft4 duration ef the level II4 procedure 
aft4 afty accompanying positive proco 
dures; aft4 



data V i 'hich reflect the staff persons who 
administered the level III procedures. 
(h^ '44*e «*e ef level fH procedures shall be i^- 
viewed at least >veekly by the treatment team ef 
its designee a«4 at least monthly by the director 
ef clinical seniceo ef a designee ef the facility di- 
rector. 44*e designee ef the facihty director shall 
ftet be a member ef the cli e nt's tr e atment team. 
Revi e ws shall be documented ift the r e cord. 

I t\ \ \i ^ n rt It 4 It .1 1 1 1' , -^ i-v T 4 Vi ,t 1 /-it -i-tl III »-tT'j-^/~-f^.-«i i«-;-i 4 1-. ft 

\Ti I..TT.ir II I" TTTC UL'VJ KJ 1 11 IV.' ITJT VT III tTTTTTTC^T^TT^Ty 1 1 l\J 

human riglit s committee shall be given the ep- 

constraints ef 44 NCAC 4*» 4tt44 ef the 
confidentiality regulations. 

I t \ 1 < ■->/'• 1 1 4 «-. f t 4 «-»-! . n^ t 4 t\--i n-i f- It ^ I 1 «-»-> --» 1 *T 4 • t 1 «T ■! W-, tj-».-A ri^ 

\ \ J IJTIt.*! I rrCTxTTTTCTTT vCTTTTT rTTTTCTT ITTTTTTTTTTTTT CT rCTTTTm 

ef the Hse ef level III procedures which shall be 
availabl e at least quart e rly te the human rights 
committee aft4 client advocate within the con 
stramts ef 44 > . C.\C 4«e ri^i^ aR4 4^.^^^ ef the 
confid e ntiality regulations. 

(h) 44ie facility director shall assure by dee- 
umentation h* the porsonnol r e cords that prior 



NORTH CAROLINA REGISTER 



925 



PROPOSED RULES 



Iraitiing m th«» w^e »f lovc ' l H+ proc^jduroD is pfe- 
vidt ' d to aW >**ff responsible fof ibeif twe ef tb« 
ro' i ic' i ' i ' »f their ws^ 

(a) Ihe interventiony spcciTicd in this Rule 
present a significant '"^l to the cbent and there- 
lore require additioi i' . guards. These proce- 
dures shall be foUoued in addition to the 
procedures specified in Rule .02(13 of this Sec- 
tion. 



(b) The following interventions are designed for 
the pnmary' purpose oT reducing the incidence of 
aggressive, dangerous or self injunous behavior 
to a lc\cl which will allow the use of less intrusive 
treatment habilitation prticedures. Such inter- 
ventions include the use of: 

( 1 ) seclusion, restraint or isolation time out 
emplo\ed as a measure of therapeutic 
treatment; 

(2) seclusion, restraint, isolation time out used 
on an emertiencv basis more than 40 



hours in a calendar month or more than (5) 

one episode of 24 hours: 
[3] unpleasant tasting loodstutYs: 
(4) planned non-attention to specific undesir- 
able beha\'iors when the target behavior 
IS health threateninii: 



(5) continizent depn\ation of any basic neces- 
sity: 

(6) contingent application of any noxious 
substances which include but are not lim- 
ited to noise, bad smells, or splashing with 
water; and 

(7) any potentially physically painful proce- 
dure or stimulus which is administered to 
the client for the purpose oJ[ reducing the 
frequency or intensity of a behavior. 

(c) Such inter\entions shall never be the sole 
treatment modality for the elimination of target 
beha\ior. the inler\ention shall always be ac- 
companied by positne treatment or habilitation 
methods which include the deliberate teaching 
and reinforcement of beha\iors which are non- 
injunous; the impro\ement of conditions associ- 
ated with non-injurious behaviors such as an 
enriched educational and social environment: and 
the alteration or elimination of en\ironmental 
conditions which are reliably correlated with 
self-injurv. 

(d) Prior to the implementation of any planned 
use of the intervention the following written ap- 
pro\als and notifications shall be obtained and 
documented in the client record: 

( 1 ) The treatment habilitation team shall ap- 
pro\'e the plan. 

(2) Hacli client whose treatment 'habilitation 
plan includes interventions with reason- 
ably foreseeable physical consequences 
shall receive an initial medical examina- 



tion and penodic planned monitoring by 
a physician. 

(3) The treatment/habilitation team shall in- 
form the internal client advocate that the 
intervention has been planned for the cli^ 
ent and the rationale for utilization of the 
intervention. 

(4) The treatment/habilitation team shall ex- 
plain the intervention and the reason for 
the inten,ention to the cUent and the le- 
gally responsible person, if applicable. 
The prior wntten consent of the client or 
his legally responsible person shall be ob- 
tained except for those situations specified 
in Rule .0204(h)(r) m this Section. If the 
chent or legally responsible person, if ap- 
plicable, refuses the intervention, the state 
facility director shall follow the right to 
refuse treatment procedures as specified in 
this Subchapter. 

1 he plan shall be reviewed and approved 
by a review committee designated by the 
state facility director. At least one mem- 



tli 



ber of the review committee shall be 
qualified through experience and training 
to utilize the planned intervention. No 
member of the re\'iew committee shaU be 
a member of the client's treatment team. 



(6) The treatment habilitation plan may be 
re\'iewed and appro\ed by the state facility 
director, at hisher option. 
If any of the persons or committees spec- 
ified in Subparagraphs (d)(1), (2), (4), (5), 
or (6) of this Rule do not approve the 
continued use of a planned intervention, 
the planned intervention shall be termi- 
nated. The state facility director shall es- 
tablish an appeal mechanism for the 
resolution of any disagreement over the 
use of the intervention. 



(e) Neither the consents nor the approvals 
specified m Paragraph (d) of this Rule shall be 
considered \alid for more than six months. The 
treatment habilitation team shall re-evaluate the 
use of the intervention and obtain the client's and 
legcdlv responsible person's consent for continued 
use of the uiter\ention. 

Ihe plan shaU be reviewed at the next 



meeting ol the human rights ad\'isory committee 
withm the constraints of 10 NCy\C 14G .0209. 



The committee, by majority \ote, may recom- 
mend appro \'al or disapproval of the plan to the 
state facility director or may abstain from making 
a recommendation. If the state facility director 
does not auee with the decision of the commit- 



tee, the committee ma\- appeal the issue to the 
division in accordance with the pro\isions of j_0 
NC.\C 14G .0208. 



926 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(g) The inten'cntion shall be used only when 
the trcatment/habilitation team has determined 
and documented in the client record the follow- 
ing: 

(1) that the cHent is engaging in behaviors that 
are likely to result in injury to self or oth- 
ers; 

(2) that other methods of treatment or habH- 
itation employing less intrusive inter- 
ventions are not appropriate; 

the frequency, intensity and duration of 
the target behavior, and the behavior's 
probable antecedents and consequences; 
and 
it is likelv that the inter\'ention will enable 



(11 



(4} itis 

the client to stop the target behavior, 
(h) The trcatment/habilitation team shall des- 
ignate a state facility employee to maintain accu- 
rate and up-to-date written records on the 
application of the intervention and accompany- 
ing positive procedures. These records shall in- 
clude at a minimum the following: 



( 1) data which reflect the frequency, intensity 
and duration with which the targeted be- 
havior occurs (scientific sampling proce- 
dures are acceptable); 

(2) data which reflect the frequency, intensity 
and duration of the inter\'ention and any 
accompanying positive procedures; and 

data wluch reflect the state facilit\' em- 



m 



plovecs who 
ventions. 



administered the inter- 



(i) The interventions shall be evaluated at least 
weekly by the treatment team or its designee and 
at least monthly by the director of clinical ser- 
vices or the state facihtv director. The designee 
of the state faciUtv director or director of clmical 
services shall not be a member of the client's 
treatment habilitation team. Reviews shall be 
documented in the client record. 



(i) During the use of the intcr\'ention, the hu- 
man n.ghts advisory committee shall be gi\'en the 
opportunity to re\iew the treatment habilitation 
plan within the constraints of J_0 NCAC 14G 
.0209. 



Statutorv Authority G.S. I22C-5I: /22C-53; 
I22C-57; I22C-60; 122C-62; BlE-67; I43B-147. 

.0207 SAFEGLARDS REGARDING 
MEDICATIONS 

f*)- Lu' i ol H- procL'duros fisay be used only i» 
omorgonoioo m accordanc e with fb-)- Bf thi^ Rulo 
e* aft or tl*e treatment team ha* dotorminod t4*at 
a lo' i' ol H prootjdure i* appropriate aft4 nocoocary 
aft4 has formulated a ' i vritten treatment ef habil 
itation plan which » ift compliance with the 
documentation aft4 ro' i 'iew protoctiono sp e cified 



duroo are inton^ontions which may be uood when 
a client oxhibita behaviors which afe Bet se wt- 

levei Hi int e n' e ntion btrt roquiio more int e noivo 
proc e duroG t4*a» a moro routin e levei J intor 
i i ^ontion. Lo' i 'ol H inter^'entions afe aft intormo 
diat e level- »f intrusion aft4 include, btrt afe aet- 
limitod te7 deprivation ef items which the chont 
» ochoduled te receive (other than basic nocossi 
ti e s), contingent deprivation ei personal pos 
sessions, r e gular use (moro tba» three timoo pef 
month) ef e xclusionary time out (dofmod as the 

IV- 17 IT^T TIT (-Tl t IIU t/irVTTT rTTTITT lilU Ct^T^^^^T Ctl^tt tTTICT^? 

the behavior occurred te a» area normally ifi- 
habit e d by a client ae4 ' ■ ' ■ hich is H©t a separate 
locked room). %f overcorrection which is set- 
painful, fa- afty ease V i horo the inten^ontion level 
is m doubt between level Hi aft4 level H7 pfe- 
teotions f&F l e v e l Hi should be used. 

\\j J TT cr L-'Livrrr 1 luvj i luu 11 11 l^? ^^n f^cttt^ 1 

intep i 'entions using afty ©f the level H ] 
identified i» (a^ ef this Rule V i ithin a 30 day pe- 
riod »f if a pattern ef disruptii i 'o behavior has 
developed, the procodure used shall be consid 
efe4 a level H proooduro aft4 shall be subj e ct t& 
the provisions »f this Rule. A treatment plan, 
as sp e cifiod ift this Pvule, shall be de^'elopod 
within 4-0 V i orldng days ef the third emergency 
inten' e ntion. 

fe^ The tr e atm e nt team shall formulate a writ 
teft treatment ©f habilitation plan including level 
H procedures which shall include, b«t is fiet- 
lirrutod t»^ 

f44 indication »f need; 

duration; 
f^ exact procedures; 
f4) methods fef measuring treatment efficacy; 

(4) guidehnos fof discontinuation &f the pro 
ceduro. 

f4) The treatment team shall explain the level 
H procedure te- the cHent. 

(e) Before implementation ef the l e vel H pfo- 
codure, the treatment team shall approve the 
treatment plan. 

{pf The treatment team shall designate a staff 
member te- maintain accurat e aft4 up to date 
V i ritton r e cords ©f the apphcation ef the level H 
procedure afi4 accompanying positive proce 
dures. 

fg)- The «se ef the l e vel H procedures shall be 
ro' i iev i ed at least monthly by the treatment team 
©f its designee aft4 at least quart e rly, if stiH ift ef- 
feetr by the director ef clinical sersices ©f a 
designee ©f the facility director. The designee ef 
the facility director Hiay aet be a member ef the 



NORTH CAROLINA REGISTER 



927 



PROPOSED RULES 



cliont's treutmont t e am. Rovicwo DhaJl be doou (4) Training aimed at education of state facil- 

miMitod m the rouord. 

fb^ "I'rt'utmL ' nt plansi vvhioh include luvol H- 
procodurtHi DhuU be [iubjoot te ruviow by tbe b»- 
man rights committet ' m complianco with 
oonfidL ' ntiaHtv a* speoiri e d m W NCAC 44G 



fH luioh troatmcnt team shall maintain a rooord 
t+f the t*se ef level H proooduroo. Such rocordo 
ef report: , shall be available te tbe human rights 
committee a«4 client advocate » acoordanco 
with t4«» contldentialitv r e gulations codified wt 4-0 
NCAC -14;» (division publication A PS VI 4^-+h 

ff^ 44te facility director shall foUow the riglit te- 
refuse treatment procedures as specified i» Rule 
.0303 »f A«v Subchapt e r. 

fk-)- -fte facility director shall assure by doc 
umentation tft t4*e personnel records Aa* training 
wt tbe **se (*f level H procedures i* provided te aH 
staff responsible fof their Hse 6»f the ro' i iew e4^ 

t t-\ ■ 11 T- 1 1 f .1 

mTTTT U Jl^ . 

fl^ I ovel H procedures shall never be the sele 
treatment modality designed te eliminate the tef- 
get- beha' i ior. I e>el 14 procedures afe te- be us e d 
consistently aft4 shall al' . vays be accompanied by 
positiv e treatment ef habilitation methods. 

(a) The state facility shall follow the Rules in 
H] NCAC 141- .0600. G.S. 122C-57. and G.S. 
Chapter QO, Articles K. 4A and 2A when utilizing 
drugs or medication. 

(b) The use of experimental drugs or 
medication shall be considered research and shall 
be go\cmed bv H) NCAC 14G .0305 and .0306 
andGJv 122C- 57(f). 

(c) 1-ach state facility which allows the use of 
neuroleptic medications shall establish the fol- 
lowing policies and procedures relative to utili- 
zation of such medications and safeguards for 
prevention of tardive dyskinesia: 



15} 



ill 
ill 



State facility plan for neuroleptic 
medication education. 



Procedures tor obtaining and renewing 
infonned consent whene\er neuroleptic 
drug therapy is administered for a period 
in excess of ten weeks. If the client's 
documented lu story reflects pre\ious 
neuroleptic drug therapy for a period of 
ten weeks or more, written mformed con- 
sent will be required prior to initiation of 
additional neuroleptic drug therapy. 
Whenever consent cannot be obtained, 



ih 



the Rules specified in Section .0400 of this 
Subchapter may be implemented. 
■Methods for minimizing the risk of tardive 
dyskinesia bv prescribing neuroleptic 
medication judiciously in low doses for 
short inten.'als. 



ity employees regarding indications for 
using neuroleptic medication, expected 
therapeutic effects of neuroleptic 
medication and common side effects in- 
cluding indications of tardive dyskinesia. 

Procedures for monitoring clients on 
neuroleptic medications for signs of 
tardive dyskinesia including the following: 

(A) designation of a standardized rating 
system; 

(B) frequency of chent ratings whenever 
tardive dyskinesia is detected or when 
pre-existing tardive dyskinesia increases in 
seventy: 

(C) training of designated raters in the se- 
lected methodology. 

Statutoiy Authority G.S. 122C-5I; 122C-57; 
I3IE-67: I43B-I47. 

.0208 PROTECTIONS FOR LEVEL I 

PROCEDLRES (REPEALED) 
.0209 SAFEGLARDS REGARDING 

MEDICATIONS (REPEALED) 



Statutory Authority 
I31E-67: 1 43 B- 147. 



G.S. I22C-5I; I22C-57; 



SECTION .0300 - RIGHT TO REFUSE 
TREATMENT 

.0301 TIIERAPELTIC .\ND DIAGNOSTIC 
PROCEDLRES 

(a) Each cUent bae the right te be free from 
surgery without consent In addition to the treat- 
ment procedures specified in G.S. 122C-57(f), 
other intrusive procedures which are not routine 
medical diagnostic or treatment procedures shall 
require the express and infonned written consent 
of the client or his 'her legally responsible person 
prior to their initiation except in medical emer- 
gencies. Such procedures shall include but are 
not limited to the following: 

( 1) Procedures that introduce radioactive dyes; 

(2) I Ivperalimentation; 

(3) Endoscopy; 

(4) Lumbar puncture; 

(5) Prescribing and, or administration of the 
following drugs: 

(A) Antabuse; 

(B) Clonodine when used for non-FDA 
approved uses; and 

(C) Depp -Pro vera when used for non-FDA 
approved uses. 

(6) Neuroleptic dmg therapy following the 
diagnosis of tardive dyskinesia or after the 
symptoms of tardive dyskinesia have ap- 
peared as obser\'ed by using a standard- 



928 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



izcd abnormal involuntary movement 
rating scale. 

(b) Non t ' mLTgency surg e ry nhall net- be pef- 
formod »«■ a client unloos the appropriate person 
h«j sign e d a standard surgical ponnission form 
stating that- th*» nature aft4 purpos e trf th« opura 
tieft Bf procedure, possible alt e rnativ e methods 
ef treatment, Ute risks involv e d, etftd the possi 
bility ef complioations have been fully explained 
a«4 tl+at- permission i« given te- administer anes 
thesia, porfunn th^ procedure, aH4 e xamine aft4 
dispose (rf aft¥ tissue remov e d, -fh^ appropriat e 
person to ska* tl+e permission form shall fee the 
legally responsible person. Non-emergency sur- 
gery', and other therapeutic and diagnostic pro- 
cedures as specified in L'aragraph (a) of this Rule, 
shall not he perionned on a client unless the cU- 
cnt or his legallv responsible person has been 
pro\ided with sufhcient information concerning 
the proposed procedure in order to make an ed- 
ucated decision about the treatment measure and 
has consented m writing. 

(c) Emergency surger\ may be performed on a 
chent without t4+e standard surgical permission 
consent as specified in (b) of this Rule only 
when: 

(1) immediate action is necessarv' to preserve 
the life or health of the chent; 

(2) the chent is unconscious or otherwise in- 
capacitated so as to be incapable of giving 
consent; 

(3) in the case of a minor or incompetent 
adult client, the consent of a the legallv 
responsible family member Bf- guardian 
person cannot be obtained within the time 
necessitated by the nature of the medical 
emergency, subject to the provisions of 
G.S. 90-21.1 et seq.; and 

(4) the attending ph\sician and a second 
physician certify in writing that the situ- 
ation requires emergency surgery. 

Statutoiy Authoritv G.S. 90-21. 1: 90-21.13; 
I22C-5I; l22C-57;'l3IE-67; I43B-I47. 

.0.^02 IM Rl Sl\ K IMERNKMIONS 
faf level ti4 t»f 1 cs'el 14- procedures as specified 
ift Pkules .n2Q6(a) m^i .0207(a) of tl4s Subchapter 
shall Hot- be adminir . tereJ to a voluntary client ift 
a non emergency situation if th« legally respon 
sible person refuses tlte procedure(6). WTien tbe 
a client or his her legally responsible person f»f 
a voluntaP i client refuses treatment or habili- 
tation utilizing inter\'entions specified in Section 
.0200 of this Subcliapter W*4 144 of k*v«4 H- fHO- 
codures in a non-emergency situation, the fol- 
lowing process shall be followed for both 
voluntaPv' and involuntar\' clients: 



(1) The qualifi e d responsible professional shall 
speak to the client aft4 or legally responsible 
person, if applicable, and attempt to explain 
his/her assessment of the cUent's condition, 
the reasons for recommending the inter- 
vention, levei iH Of level 44 procoduros, the 
benefits and risks, and the advantages and 
disadvantages of alternative courses of 
action. If the chent or his/her legally re- 
sponsible person still refuses to participate 
and the qualified responsible professional 
still believes that these procoduros inter- 
ventions are a necessary part of the chent's 
treatment or habihtation plan: 

(A) (a) The qualified responsible professional 
shall tell the chent and the legally respon- 
sible person, if applicable, that the matter 
will be discussed at a meeting of the cU- 
ent's treatment /habihtation team; 

f&^ (b} If the chent's condition permits, the 
qualified responsible professional shall in- 
vite the chent and the legally responsible 
person, if apphcable, to attend the meet- 
ing of the treatment /habihtation team; 
and 

fG) (c} The qualified responsible professional 
shall suggest that the chent and the legally 
responsible person, if applicable, discuss 
the matter with a person of his/her own 
choosing such as a relative, friend, or 
internal chent advocate. 

(2) If tbe a voluntary client or his/her legally 
responsible person stiU refuses the procoduro 
inter\'ention after the process in Paragraph 
faf (1) of this Rule has been followed and if 
the use of the level 144 of level H procedure 
intervention is still determined to be essen- 
tial to the treatment or habihtation of the 
voluntary client by the treatment /habih- 
tation team and no alternative procedures 
are appropriate, the treatment /habihtation 
team shall make a determination as to 
whether the chent meets the requirements 
for involuntary commitment. 

fA^ (aj If the chent meets the requirements for 
involuntary commitment, as specified in 
G.S. Chapter 122 C^ Article 5, A7 the 
treatment /habihtation team may make a 
written recommendation to the state fa- 
cility director requesting the initiation of 
commitment proceedings. 

(4if (hi If the chent does not meet the require- 
ments for involuntary commitment, as 
specified in G.S. Chapter 122 C^ Article 
5, At the treatment 'habihtation team may 
make a written recommendation to the 
state facihty director requesting the dis- 
charge of the chent. 



NORTH CAROLINA REGISTER 



929 



PROPOSED RULES 



{G^ (c} The state facility director may designate 
a group to investigate the circumstances 
and to recommend appropriate action. 
Such a group shall include, but not be 
limited to, representatives from the hu- 
man rights advisory- committee, client ad- 
vocates, and qualified professionals m 
supervisory- positions. 
(3) Interventions as specified in Rules .0203 
through -1)2116 of this Section shall not be 
administered to a \oluntar\' client m a non- 



emert:enc\ situation if the client or his her 
lc<:all\- responsible person refuses the 
Lnler\cntion(s). 
(^ H] ^^ hen If an Ln\ oluntary chent or his h er 
leealJN- responsible person, if applicable, re- 
fuses treatment or habihtation utilizing lovol 
144- »f Ic i c'l 14 procL'durL'D inten.'entions spec- 
ified m Rules .0203 through 0206 of this 
Section m a non-emergency situation, after 
the process in Paragraph ( 1 ) of this Rule has 
been followed and if the use of the inter- 
\enlion is still determined to be essential to 
the treatment or habililation of the involun- 
tary' chent by the treatment habilitation 
team and no altemati\e approaches are ap- 
propnate. the treatment habililation team 
shall meet to re\ie\v the in\'oluntar\' chent's 



or his her legally responsible 

s£onse and assess the need for the inter- 



person s re- 



\ention as follows: tbe foUovsing prococ . L i 
shall be follmvt ' d: 
f44 ^-ht* qualified profL" .' ' . ional oliall sp e ak k» thi» 
client a«4 attempt k* e .^plain Ino hijr ascooo 
mcnt ©f tht* client condition, tlw roasonc 
fof rc ' commending (4*e Io' i l'1 H-t t+f level H- 
procedures, th^ benefits aft4 risks. a«4 tht? 
adsantages rtft4 disad' i iintages »f altemativo 
courses ef action. M tl*e client ^4*11 refuses 
t»- participat e aft4 t4** qualified professional 
s+*W believes tb*t- these procedures afe a 
necessaP i' {*«* ei t4w client s treatment et 
habililation plan: 
frV+ -!-4» qualified professional shall tell t4*t» 
client tha* tl** matter will bi* discussed a4- 
a meeting ef tfee client's treatment team; 
fS) 14 tbe ch e nt s condition p e rmits. t4*e 
qualifi e d professional shall in' , ite tl*# client 
te attend A<? meeting ef Ai* treatment 
team; aad 
fQ} The qualified professional shall suggest 
ttet- the client discuss the matter wrth a 
person ef his her twrft choosuig such as a 
relative. I'nend, guardian ©f chent advo 

f34 The treatment loam shall m ee t ^ r e ' i 'i e w the 
msolunlar .' client o response aft4 ass e ss t4ie 



need fo* lovol H4 ef lev e l H- proooduroo as 

follows: 
frV^ (a) If the chent or legally responsible per- 
son is present, the treatment habihtation 
team shall attempt to formulate a treat- 
ment or habihtation plan that is accepta- 
ble to both the chent or legally responsible 
person and the treatment habililation 
team. The chent or legally responsible 
person may agree to participate in the 
treatment or habihtation program uncon- 
ditionally or under certain conditions that 
are acceptable to the treatment habih- 
tation team. 
f&> (h]_ If the chent or legally responsible per- 
son is not present, the treatment habih- 
tation team shall review its previous 
recommendations and the chent's re- 
sponse and shall document their decision 
in the client record. 
<4^ (5| If. after reassessing the need for these 
procedur e s, the inter\'entions. the treatment 
habihtation team still beheves that the pro- 
cedures are a necessary part of the involun- 
tary client's treatment or habihtation plan 
and the chent or his her legally responsible 
person, if applicable, still refuses, the direc 
(Of ef clinical sep . icos ef designee »f tl*e fo- 
cility director client's treatmg physician and 
another physician, \sho may be the clinical 
director or his her designee, shall interview 
the chent and review the record. If the 4i- 
roolor &f clinical ser < 'ices »f tl*e designee ©f 
the facility director agrees ' ■ vilh the tr e atment 
team, the procedures both physicians deter- 
mine that the inter.'enlion is essential, in 
accordance with G.S. 122C-57(e). the inter- 
Ncntion may be administered as part of the 
competent chent's documented individual- 
ized treatment or habihtation plan. M the 
ch e nt is incompetent ©f a minor, the quah 
fie4 professional shall attempt to s e cure the 
consent ©f the l e gally responsible person. 
U the chent's guardian ©f parent, after rea- 
sonable notice ©f the propos e d action aft4 a 
request fef consent, refus e s ©f neglects te- 
submit \st vrriting either the grant ©f d e nial 
©f consent, the director ©f clinical sen'ices 
©f design ee ©f the facihty director Fftav ap- 
prove the administration ©f the level H-l ©f 
level 14- procedures. This decision shaU he 
documented m the client record. 
(6) The treating physician shall document the 
decision relali\'e to the utihzation of the 
inter\'ention in the chent record. Such doc- 
umentation shall also include consideration 
of negati\'e e fleets related to the specific 
treatment habililation measure. 



9^0 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Statutory Authority G.S. J22C-5I; I22C-57; 
13IE-67; I43B-I47. 

SECTION .0400 - REFUSAL OF 
PSYCHOTROPIC MEDICATION 

.0401 ADMINISTRATION OF MEDICATIONS 
IN AN EMERGENCY 

(a) For the purposes of the rules in this Sec- 
tion, "emergency" means a situation in which a 
client is in imminent danger of causing physical 
harm to self or other persons unless there is rapid 
intervention by the staff state facility employee in 
the form of the administration of psychotropic 
medication. 

(b) ^^^len a client in a state facility refuses 
psychotropic medication in a situation that con- 
stitutes an emergency, the director of chnical ser- 
vices as dofmod » m NCAC 44^ .0102(11), may 
authorize administration of the psychotropic 
medication upon written certification that 
psychotropic medication is essential in order to 
prevent the client from causing imminent phys- 
ical harm to self or other persons. 

(c) If it is impossible to comply with the pro- 
cedure in (b) of this Rule without jeopardizing 
the life of the cbcnt or other persons, the 
medication may be administered upon a physi- 
cian's written or verbal order. 

(d) In any situation falling within (b) or (c) of 
this Rule, the physician authorizing the 
psychotropic medication shall immediately doc- 
ument the authorization with such documenta- 
tion including a statement describing the 
circumstances making the medication necessary 
and setting forth the reasons why lesser intrusive 
alternative measures would not have been ade- 
quate. 

(e) Within 24 hours, or when imminent danger 
has passed or upon expiration of the physician's 
order, whichever comes first, the use of 
psychotropic medication shall be re-evaluated by 
the physician. Continuation of the adminis- 
tration of psychotropic medication in an emer- 
gency after the re-evaluation by the physician 
shall be permitted for up to 48 hours after written 
approval by the clinical director. If the emer- 
gency no longer exists then the procedures speci- 
fied in Rules .0403 and .0404 of this Section shall 
apply. 

(f) The occurrence of three emergency episodes 
within a 30-day period where psychotropic 
medications are administered shall constitute the 
need for the treatment team to review the 
treatment, habilitation plan. The treatment team 
shall develop a plan to respond to future crisis 
situations. 



Statutory Authority G.S. I22C-5I; I22C-57; 
I3IE-67; I43B-I47. 

.0402 BEST INTEREST TEST 

(a) The facility staff responsible professional 
shall document in the client record that the ad- 
ministration of psychotropic medication against 
the client's will is in the best interest of the client. 
"Psychotropic medication administration is in 
the best interest of the client" means that: 

(1) the client presents an imminent physical 
threat to himself, other clients, or staff 
state facility employee (Behavior consti- 
tuting such threat shall be explicitly doc- 
umented in the client record.); 

(2) the cUent is incapable without medication 
of participating in any treatment plan 
available at the state facility that wUl give 
him/her a realistic opportunity of im- 
proving his/her condition; or 

(3) although it is possible to devise a treat- 
ment plan without psychotropic 
medication which will give the client a re- 
alistic opportunity of improving his/her 
condition, oithor: 

(A) a troatmont plan which includ e s 
p i r . yohotropio medication ' i sould probably 
improvo the client 'o condition within a 
C i ignificontly ohortor timo period; m- 

{^ there is a significant possibility that the 
client win harm himself or others before 
improvement of his/her condition is real- 
ized if medication is not administered. 

(b) In addition, the following factors shall be 
considered when determining if psychotropic 
medication administration is in the best interest 
of the client, and the responsible professional 
shall document such considerations in the client 
record: 



(1) the client's reason for refusing medication; 

(2) the existence of any less intrusive treat- 
ments; and 

(3) the risks involved and severity of side ef- 
fects associated with administration of the 
proposed medication. 

Statutory Authority G.S. 122C-5I; I22C-57: 
I3IE-67; I43B-147. 

.0403 REFUSAL IN STATE FACILITIES 
OTHER THAN MR CENTERS 

(a) This Rule applies to all state facilities as 
dofmod m +© NCAC 44G Mi^ with the excep- 
tion of mental retardation centers. Mental re- 
tardation centers shall comply with Rule .0404 
of this Section. 



NORTH CAROLINA REGISTER 



931 



PROPOSED RULES 



(b) In the case of an emergency, procedures 
specified in Rule .0401 of this Section shall apply. 

(c) In the case of a client's refusal of 
psychotropic medication in a non-emergency, the 
best interest test as specified in Rule .0402 of this 
Section shall apply in the absence of a valid order 
requiring the administration of psychotropic 
medication issued from a court of competent ju- 
risdiction. 

(d) Administration to Involuntary Inoompotont 
Clients. 

( 1) When an involuntary chcnt v . 'ho hae boon 
adjudiuatod inoompotont Bf a- minor who 
b*» boon oommittod or his/her le,gall>' re- 
sponsible person refuses psychotropic 
medication in a situation that is not an 
emergency, the following procedures are 
required: 
fH (A) if a cliont rufuooo to tek« tfee 
psychotropic modioation frt^at ha* boon 
pro ' X-'ribod fef hio hor, The attending phy- 
sician shall speak to the client or legally 
responsible person, if applicable, and at- 
tempt to explain liis/her assessment of the 
client's condition, hiohor the reasons for 
prescribing the medication, the benefits 
and risks of taking the medication, and the 
ad\antages and disadvantages of alterna- 
tive courses of action. If the client or 
his her legally responsible person still re- 
fuses and the physician still believes that 
psychotropic medication administration is 
in the best interest of the client as specified 
in Rule .0402 of this Section: 
(A) [i| the physician shall tcU the client 
and the legally responsible person, if 
applicable, that the matter will be dis- 
cussed at a meeting of the client's treat- 
ment team; 
(4i^ [ii} if the client s clinical condition 
permits, the physician shall invite the 
client and the legally responsible per- 
son, if apphcable, to attend the meeting 
of the treatment team; and 
fG^ (iii) the physician shall suggest that 
the client and the legally responsible 
person, if applicable, discuss the matter 
with a person of his/her own choosing, 
such as a relative, friend, guardian or 
client advocate, 
f^ [B) The treatment team shall meet to 
review the client's or legally responsible 
person's response and assess the need for 
psychotropic medication. 
fi\i [i) If the client or legally responsible 
person is present, the treatment team 
shall attempt to fonnulate a treatment 
or habilitation plan that is acceptable to 



both the client or legally responsible 
person and the treatment team. The 
client or legally responsible person may 
agree to take medication uncondi- 
tionally or under certain conditions that 
are acceptable to the treatment team. 
f8) (ii) If the client or legally responsible 
person is not present, the treatment 
team shall review its previous recomm- 
endations and the client's response and 
shall document their decision in the cli- 
ent record. 
(^ £C) If, after assessing the need, the treat- 
ment team still believes that psychotropic 
medication administration is in the best 
interest of the client as specified in Rule 
.0402 of tlris Section and the client or le- 
gally responsible person still refuses te 
trik^ administration the prescribed 

.11 IV- VJ1V..C1.L Iv^ 1 1 , 11 IV Vl II VV C \.n. KJl \J 111 IITJUl U^'I T^^?^^? 

ef hiS) hor physician dooignoo ' . ' ■ 'ho \% eet- 
a mombor ef tit» cliont 'o troatmont toam 
shall intoP i iow the cliont aft4 review tfee 
record. +f the dir e ctor Bi clinical sor^'iooo 
ef hiii/hor physician dosignoo who is eet 
a mombor »f tiie oliont's troatmont toam 
agrooo with the troatmont toam, the pfe- 
scribing physician shall attempt te- secure 
the consent trf the guardian. At that tim e 
the risks, bonofits, aft4 disadvantugos shall 
be dosoribod ift detail. if the client's 
guardian, after reasonable notice ei the 

rofusos »f noglocts ta submit i«- writing 
either the grant ©f denial &( consent, the 
director ei clinical sor i 'icoo e* his/her 
physician dosignoo wh» k, ft»t a member 
&f the cUont's treatment toam faay ^- 
provo the administration ef the 
modioation »vef tfee objection ef the Gt- 
ewtr the director of clinical services or 
his/her physician designee, who is not a 
member of the client's treatment team, 
may approve the administration of the 
medication over the objection of the client 
and legally responsible person. 

(2) Such refusal shaU be documented in the 
client record. 
(e) Administration to Voluntary Clients. 

(1) When a voluntary client in a state facihty 
refuses psychotropic medication in a non- 
emergency situation, that is net aft omor 
gency, the medication shall not be 
administered to: 
{^ (A} a competent ' . oluntary adult client 

without the client's consent; 
(^ (B) an incompetent adult client Vrhe- ha* 
boon adjudicated incompetent without the 



932 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



gucudiun'fi consent »f of the legally re- 
sponsible person; or 
(^ (C| a minor client without the consent 
of the guardian »f parent . legally respon- 
sible person. 
(2) Such refusal shall be documented in the 
client record. 



{pf Adminif . tration te Involuntary Competent 

I\. 1 1 1 J . ' * 1 1 V- 1 1 CTTT 13 T TT^ 1 LI i i I LLl 1 CTTCTTT tTTTTT I IUJ IT^tT 

boon adjudicated incompetont refuses 
P ' jyohotropio modic ^ ation i» a situation tfeat- i* Hel- 
aft emergency, Ae foUo' i ' . ing procedures are Fe- 
quired: 

f4-^ tt tiw client refuses te teke A<* 

psychotropic medication Atri- ha* boon 
prescribed fe* him her. the att e nding 
physician shall spealt to the cli e nt aft4 at- 
tempt k* explain his ' h e r assessment ef the 
client's condition, reasons fof prescribing 
the medication, the benefits aft4 risks ef 
taking the medication. aft4 the advantages 
aftd- disadvantages ef alternative courses 
»f action. U the client sttH- refuses te take 
the medication aR4 the physician st*y he- 
lioses that psychotropic medication ad- 
ministration » ift the best mt e rest ©f the 
client as specified » Rule .0102 trf thi* 
Section: 
(-A-^ the pliy ^. ician shall teh the client that 
the matter wth he di ^i cussed at a meeting 
»f the client's treatment team; 
fft^ if the client's clinical condition permits. 
the physician shall in' < ite the client te- at- 
tond the meeting ef the treatment teain; 

fG^ the physician shall sugg e st that the eh- 
eftt discuss the matter with a person &f 
hisher ©wft choosing, such as a relative, 
friend Bf client advocat e . 
(-3^ 44w treatment team shall moot te review 
the client's response nf^ assess the need 
fof psychotropic medication as follo' i ' i s: 

fA-)' W the client » present, the treatment 
team shall attempt t» formulate a tr e at 
mont Bf habilitation plan that is acc e pta 
We te- both the client a«4 the treatment 
team. ^4*e cUont may agree te take 
medication unconditionally ef under eef- 
ta*ft conditions that afe acceptable te the 
treatment team. 

f&f U the client is Bet present, the treatm e nt 
team shall review its previous recommen 
dations aft4 the client's response aft4 shaU- 
document their decision ift the cli e nt re- 
cord. 
(4) Ut after assesi i ing the need, the treatment 
team stih belio' i os that psychotropic 
m e dication administration is ift the best 



interest ef the client as specified m Rule 
■O ' lOJ ef this S e ction afi4 the client st+ii 
refusoo te take the prescribed m e dication. 
th e n the director ef clinical sor i 'iooo ef 
his/her physician dosignoo whe is net a 
member ef the oliont'o treatment team 
shall inten'iosv the cbent aft4 review the 
record. U the director ef clinical ser i icos 
ef liis ' her physician dosignoo who is net 
a member ef the client's treatment t e am 
agrooo with the necessity fef medication, 
the medication H+ay he administorod as 
part ef the client's documented individ 

\^ U.11 /-. VJVl 11 VH 1 1 1H_ III CTT I TTJ. \J HI I U I H/ T 1 T^^T^^T CTT^T 

the objection ef the client. 
(fl (Jl Independent Psychiatric Evaluation. 

(1) Wlienever the director of clinical services 
is asked to review a psychotropic 
medication decision, the director of clin- 
ical services may retain an independent 
psychiatric consultant to evaluate the cli- 
ent's need for psychotropic medication. 
The use of psychiatric consultant may be 
particularly indicated in cases where there 
is a disagreement between the prescribing 
physician and other members of the 
treatment team. 

(2) If the client is evaluated by an independent 
psychiatnc consultant, the director of 
cluneal services shall fde a report in the 
client record indicating: 

(A) the recommendation of the consultant; 
and 

(B) why the director of clinical ser\'ices 
made a decision to follow, or not to fol- 
low, the consultant's recommendation. 

(4*) {zl Case Re\ievv by the Director of Clinical 
Services. 

(1) The director of clinical services or his, her 
physician designee shall re\'iew each week 
the treatment or habihtation program of 
each client who is refusing to accept 
psychotropic medication administration 
voluntarily to determine: 

(A) whether the client is still receiving the 
prescribed medication; 

(B) whether psychotropic medication is still 
in the best interest of the client as specified 
in Rule .0402 of this Section; and 

(C) whether the other components of the 
client's treatment or habilitation plan are 
being implemented. 

(2) The director of clinical services (not 
liis 'her designee) shall review quarterly the 
treatment or habilitation progtcim of each 
client who is refusing to accept 
psychotropic medication administration 
voluntarUv to determine: 



NORTH CAROLINA REGISTER 



933 



PROPOSED RULES 



(Al whether the client is still receiving the 
prescribed medication; 

(B) whether psychotropic medication is stiU 
in the best interest of the client as defmed 
in Rule .0402 of this Section; and 

(C) whether the other components of the 
clients treatment or habilitation plan are 
being implemented. 

(+> (h) Documentation. 

( 1) Hach step of the procedures outlined m 

Paragraphs (d) through (fe) (g) of this 
Rule shall be documented in the chent 
record. 

(2) \\Tienever the client or his her legally re- 
sponsible person has refused the admmis- 
tration of ps\chotropic medication and 
later agrees to such administration, the 
documentation of consent, either verbal 
or wntten, shall be included in the client 
record. 

(i) A client s willingness to accept medications 
administered bv mouth m lieu of accepting 
medications administered bv an intramuscular 
route does not necessanlv constitute consent. 



The responsible professional shall ensure that the 
client IS indeed wiUing to accept the medication 
and IS not responding to coercion. 

(j) Statistical Record. I he state facility director 
shall maintain a statistical record of the use of 
psNchotropic medication against the client s will 
which shall include, but not be limited to. the 
number of administrations bv client, unit of like 
grouping, responsible ph\ sician. and client char- 
acteristics. The statistical record shall be made 
a\ailable to the di\ ision director and human 
nalits advisoPv' committee on a monthly basis. 



Slatuton- Auihohty G.S. I22C-5I; I22C-57; 
l31E-6^; I43B-I47. 

.0404 REFi;S.\L IN REGION.\L MENT.AL 
RETARD.VnON CEM KRS 

(a) Ihis Rule applies to mental retardation 
centers, a^ defined m -W NCr\C 44^ t^442. /\ll 
other state facilities shall comply with Rule .0403 
of this Section. 

(b) In the case of an emergency, procedures 
specified in Rule .0401 of tins Section shall appl\-. 

(c) In the case of a client's refusal of 
psychotropic medication in a non-emergency, the 
best interest test as specified in Rule .0402 of this 
Section shall apply. 

(d) Medication Refusal Incident Defmed 

(1) A medication refusal incident is defmed 
as any behavior on the part of the client, 
be it verbal or non-verbal, or legally re- 
sponsible person, which is judged to be 
an attempt to communicate an unwilling- 



ness to have psychotropic medication ad- 
ministered to the client. 
(2) Given the characteristics of the mentally 
retarded population, some very common- 
place acts that may not necessarily con- 
stitute refusal should be considered. 
These may include; 

(A) passivity or the lack of active partic- 
ipation in various activities which may 
require physical prompting such as hand 
o\er hand manipulation m order to learn 
a particular skill or complete a particular 
task; 

(B) spitting out medication because of 
objectionable texture or taste (Therefore, 
disguising the texture or taste of 
psychotropic medication with a pleasant 
tasting vehicle such as applesauce or 
pudding may not necessarily be consid- 
ered administration against the client's 
will.); or 

(C) tantrums, self-injurious behavior, ag- 
gressive acts, etc. which would not auto- 
matically be judged to represent a client's 
attempt to refuse medication. However, 
it is recognized these behaviors in some 
cases may indeed be the only form of 
communication a client may have with 
which to express his or her refusal. 

(e) Admmistration of Medication in Non- 
L'mergency Situations. When a minor or adult 
client or their parent »f guardian his her legally 
responsible person refuses psychotropic 
medication in a situation that is not an emer- 
gency, the following procedures are required: 

( 1 ) If a staff member state facility employee 
suspects that a client may be attempting 
to refuse psychotropic medication, the 
staff member state facility employee shall 
notify the client's qualitied mental retar- 
dation professional (QMRP) and the ch- 
ent's internal ad\'ocate. 

(2) If the Q.MRP agrees that the client may 
be attempting to refuse psychotropic 
medication the Q.MRP shall notify the 
client's internal advocate and shall assem- 
ble the client's treatment team, including 
the treating physician, to assess the refusal 
incident. 

(A) In the case of a client who is suspected 
of refusing, the team shall make a decision 
as to whether the client's beha\iors, be 
they verbal or non-\erbal, are true indi- 
cations of refusal. In those instances 
where behavior is determined not to be 
refusal, authorization for the continued 
administration of the psychotropic 
medication may be sdven. 



954 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(B) In those cases where behaviors cUl 
judged to be refusal or when refusal origi- 
nates with the competent adult client or 
with the client's parent ef guardian, legally 
responsible person, the client when possi- 
ble or appropriate and the legally resp>on- 
sible person shall be invited to meet with 
the team to resolve the issue. 

(C) The physician shall explain the reasons 
for prescribing the mediation, the benefits 
and risks of taking the medication and the 
advantages and disadvantages of alternate 
courses of action. The team shall maVe 
every effort to develop a habilitation plan 
or specific form of treatment that would 
be agreeable to the client and/or his/her 
parents »f guardian legally responsible 
person and still be consistent with the 
treatment needs of the client. 

(3) In those cases where an agreement cannot 
be reached between the treatment team, 
including the physician, and the legally 
responsible person, and the team, includ- 
ing the physician, still feels that 
psychotropic medication administration is 
in the best interest of the client, the issue 
shall be referred to the institution review 
committee appointed by the state facility 
director. 

(A) The composition of this committee 
should include a complement of profes- 
sionals, including the medical director (or 
his/her designated physician) and human 
rights committee representatives. The 
internal client advocate shall be invited to 
represent the client's interest but not be 
considered a member of the institution 
review committee. The committee should 
not include poroonncl state facility em- 
ployees providmg direct services to the 
client refusing the psychotropic 
medication. In any event, the 
confidentiality regulations as codified in 
10 NCAC 18D shall be foUowed. 

(B) As with the treatment team, the insti- 
tution review committee shall involve the 
client and the legally responsible person 
where appropriate in an attempt to arrive 
at a mutually acceptable solution. 

(C) If agreement is reached between the le- 
gally responsible person and the institu- 
tion review committee, no further 
proceedings are necessary. If agreement 
cannot be reached the institution review 
committee shall forward its recommen- 
dations concerning any changes in treat- 
ment or support of existing treatment 
methods to the center director. 



(4) If the center director receives recommen- 
dations concerning any changes in treat- 
ment or support of existing treatment 
methods regarding a specific client who 
has refused psychotropic medications and 
this recommendation is still unacceptable 
to the legally responsible f>erson, the cen- 
ter director shall have, as the last alterna- 
tive, the authority to discharge the chent 
under G.S. 122 71.1. 122C-57(d). In 
those cases where the center director 
makes the decision to discharge the client, 
information shall be provided to the le- 
gally responsible person regarding the 
grievance procedures as specified in 10 
NCAC 14H .0203, .0204, and .0205. 

(f) Documentation. Each step of the procedure 
outlined in (d) through (e) of this Rule shall be 
documented in the client's record. 

(g) Statistical Record. The state facihty direc- 
tor shall maintain a statistical record of the use 
of psychotropic medication against the client's 
will which shall include, but not be limited to, 
the number of administrations by chent. unit of 
like grouping, responsible physician, and client 
charactenstics. The statistical record shall be 
made available to the division director and hu- 
man rights ad\isor\' committee on a monthly 
basis. 

Statutory Authoritv G.S. I22C-5I: 122C-57; 
I22C-242: I43B-I47. 

SLBCHAPTER UK - CORE LICENSURE RULES 

FOR MENTAL HEALTH: MENTAL 

RETARDATION AND OTHER 

DEVELOPMENTAL DISABILITIES: AND 

SUBSTANCE ABUSE FACILITIES 

SECTION .0200 - LICENSURE 

.0219 DEEMED STATUS 

(a) If an inpatient psychiatric facility or inpa- 
tient sub.stance abuse treatment facility is sur- 
veyed and accredited by the Joint Commission 
for the Accreditation of Healthcare Organiza- 
tions, the commission deems the faeUity to be in 
compliance with applicable rules codified in 10 
NCAC 14K through 140 with the exception of 
the foUowing rules: 10 NCAC 14K .0101 
through .0103; 14K .0201 through .0208(a)(3); 
14K .0208(a)(5) through .0212; 14K .0213(b) 
through .0219; 14K .0311; 14K .0327; 14K .0330 
through .0332; 14K .0342; 14K .0355; 14K .0401 
through .0404 and, for inpatient substance abuse 
treatment services only, 14N .0103(c). 

(b) Deemed status may be provided only if the 
facility shall agree to provide to DPS copies of 
the following documents: 



NORTH CAROLINA REGISTER 



9i5 



PROPOSED RULES 



( 1 ) JCAI 10 statement of construction and fire 
protection (as submitted to JCAHO by 
the accredited facility); 

(2) JCAHO reports and recommendations; 

(3) JCAHO focused survey reports; 

(4) Accredited facility progress reports which 
have been sent to the facility by JC^AHO; 
and 

(5) Fennission to participate in any regular 
survey conducted by the JCAHO. 

(c) /\ny facility licensed under the provisions 
of the rules contained in 10 NCAC 14K through 
140 shall, ho\ve\er, continue to be subject to 
inspection by the secretary. 

Statmon- Authority G.S. I22C-22: I22C-26: 
1 43 n- 147. 

CH.APTER 15 - MENTAL HEALTH HOSPITALS 

SUBCHAPTER 15A - GENERAL RLLES FOR 
HOSPITALS 

SECrrON .0200 - \ OLLNTARV ADMISSIONS: 

IN\ OI.LNTARY COMMITMENTS AND 

DISCHARGES OF MINORS TO AND FROM 

REGIONAL PSYCHIATRIC HOSPITALS 

.0204 PURPOSE 

The rules in this Section specify procedures for 
voluntary admissions, in\oluntar>' commitments, 
and discharges of minors to and from the regional 
psychiatric hospitals. These rules also specify the 
responsibilities of area programs and hospitals for 
coordinating the admission, treatment and dis- 
charge of minors. These rules do not apply to 
Wnght School, WHiitaker School or the Chil- 
dren's Fs\chiatric Lmt at John Umstead Hospi- 
tal. 

Statutory Authoritv G.S. 122C-22I through 
I22C-223: I22C-224.7: I22C-26I: I22C-262; 
I43D-I47. 

.0205 SCOPE 

The rules in this Section shall be followed with 
regard to minors by hospital and area program 
staffs, and other appropriate professionals as 
specified in G.S. 122C-222. /Vrea program child 
and youth coordinators and hospital child and 
youth unit directors shall develop their policies 
and procedures regarding inpatient referrals and 
discharge planning in accordance with these 
rules. 

Statutorv Authority G.S. I22C-22I through 
J22C-223; I22C-224.'': I22C-26I: I22C-262: 
I43B-147. 



.0206 DEFINITIONS 

For the purpose of the rules in this Section, the 
following terms shall have the meanings indi- 
cated: 

(1) "Child and youth coordinator" means that 
individual charged by the area program to 
develop and administer mental health ser- 
vices for minors. 

(2) "Child and youth unit director" means that 
individual charged by the regional psychiat- 
ric hospital to develop and administer men- 
tal health services for minors. 

(3) "EUgible psychologist" means a licensed 
practicing psychologist who has at least two 
years clinical experience. 

(4) "Emergency involuntary commitment" 
means admission to a hospital when a minor 
has met the criteria specilied in G.S. 122C- 
262. 

(5) "Hospital" means one of the regional psy- 
chiatric hospitals of the division. Wright 
School, Whitaker School and the Children's 
Fsychiatric Unit at John Umstead are ex- 
cluded from this definition. 

(6) "Legally responsible person" has the me- 
aning specified in G.S. 122C-3(20). 

(7) "Referring agent" means the practitioner 
authorized to refer minor clients to a hospi- 
tal. In single portal areas this is the child 
and youth coordinator or his designee. In 
non-smgle portal areas, this is the child and 
youth coordinator or his designee, a Licensed 
physician or an eligible psychologist. 

(8) "Regional child and family coordinator" 
means the individual in each regional office 
who coordinates the development of mental 
health services for minors. 

(9) "Regional screening committee" means the 
regional committee that reviews the records 
of minors for the purpose of making place- 
ment recommendations to Wright School, 
Wliitaker School, and the Children's Fsy- 
cliiatric L'nit at John Umstead Hospital. 

(10) "Single portal area" has the meaning spe- 
cified in G.S. 122C-3(35). 

(11) "Voluntar)' admission" means admission 
to a hospital for evaluation and treatment 
consented to by the minor's legally respon- 
sible person, or self admission in accordance 
with G.S. 122C-223. 

(12) "WiUie \I. coordinator" means that indi- 
vidual charged by the area program to de- 
velop and administer mental health services 
for WiUic \I. class members. 

Statutory Authority G.S. /22C-3; I22C-22I; 
143B-I47. 



936 



ISORTH CAROLINA REGISTER 



PROPOSED RULES 



.0207 \\ KITTEN CONSKNT FOR RELEASE 
OF INFORMATION 

Except as otherwise provided in G.S. 122C-53 
through G.S. 122C-56, the written consent of the 
minor's legally responsible person shall be ob- 
tained prior to the release of confidential infor- 
mation. 

Statutory Authority G.S. I22C-53 through 
I22C-56; 1438- 1 47. 

.0208 ^^ KITTEN APPLICATION FOR 
VOLLNTARY ADMISSIONS 

(a) The minor's legally responsible person may 
apply in writing for the admission of the minor 
to a hospital with or without the consent of the 
minor. 

(b) In an emergency situation, a minor may be 
voluntarily admitted upon his own written ap- 
plication, in accordance with the provisions of 
G.S. 122C-223. 



Statutory Authority G.S. I22C-3; 
through ' I22C-223; 1 43 B- 1 47. 



I22C-22I 



.0209 MANDATORY SCREENING 

Except as provided in G.S. 122C-223 and 
122C-262, all minors shall be screened in ac- 
cordance with Rule .0214 of this Section prior to 
admission to a hospital. 

Statutoty Authority G.S. I22C-221 through 
I22C-223: I22C-262: I43B-I47. 

.0210 TELEPHONE NOTIFlC.\TION OF 
HOSPITAL BY REFERRING AGENT 

(a) During working hours, the referring agent 
shall telephone the child and youth unit director 
or his designee regarding an imminent admission 
or commitment. 

(b) .After working hours, the referring agent 
shall telephone the hospital admission staff re- 
garding an imminent admission or commitment. 
Immediately upon receiving such telephone no- 
tification, the hospital admissions staff shall no- 
tify the designated representative of the child and 
youth unit director. 

Statutory Authority G.S. I22C-221; /22C-222; 
I22C-26I: 1438-147. 

.021 1 REFERRALS FROM SINGLE PORTAL 
AREAS 

(a) In single portal areas, the child and youth 
coordmator or his designee may refer a minor 
directly to a hospital. 

(b) In single portal areas, all professionals and 
agencies shall refer all prospective minor admis- 



sions to the child and youth coordinator or his 
designee, 
(c) Except as provided in G.S. 122C-223 and 
I22C-262, referrals not made in accordance with 
this Rule shall be directed by hospital staff to the 
child and youth coordinator or his designee as 
specified in thi R ule. 

Statutory Authority G.S. I22C-22I; I22C-223; 
I22C-26I; I22C-262; 1438-147. 

.0212 REFERR\LS FROM NON-SINGLE 
PORTAL AREAS 

(a) In non-single portal areas, licensed physi- 
cians, eligible psychologists or the child and 
youth coordinator or his designee may refer a 
minor directly to a hospital. 

(b) In non-single portal areas, all professionals 
and agencies other than hcensed physicians and 
eligible psychcilogists shall refer all prospective 
minor admissions to the persons listed in Para- 
graph (a) of this Rule. 

(c) Except as provided in G.S. 122C-223 and 
122C-262, referrals not made in accordance with 
this Rule shall be directed by hospital staff to the 
appropriate persons or agencies as specified in 
this Rule. 

Statutory Authority G.S. 122C-222; 122C-223; 
122C-261: 122C-262; 1438-147. 

.0213 LSE OF STANDARDIZED REFERRAL 
FORM 

All referrals shall be in writing on the standard- 
ized referral form in duplicate. One copy of the 
form shall be filed at the area program and one 
copy shall be sent to the hospital. 

Statutory Authority G.S. 122C-221; 122C-222; 
122C-261: 1438-147. 

.0214 SCREENING BY REFERRING AGENT 

(a) As part of the referral process for hospital 
admission, except admissions under G.S. 122C- 
223 and 122C-262, the appropriate referring 
agent as specified in Rules .0211(a) and .0212(a) 
in this Section shall determine that: 

(1) there is the presence or probably presence 
of mental illness; and 

(2) less restrictive treatment measures are 
likely to be ineffective. In making this 
judgment, the referring agent shall deter- 
mine that: 

(.A) outpatient treatment or less intensive 
residential treatment measures would not 
alleviate the mental illness; 

(B) there is no local inpatient unit that 
meets the needs of the minor; and 



NORTH CAROLINA REGISTER 



937 



PROPOSED RULES 



(C) the minor's priman' need is not foster 
care, group child care or correctional 
placement. 

(b) Additionally, the referring agent shall pro- 
vide the following written information, to the 
extent possible: 

(1) name of the professional at the area pro- 
gram or other setting who has provided 
diagnostic or treatment services to the cli- 
ent; 

(2) fuU name of client, including maiden 
name, if applicable; 

(3) legal county of residence; 

(4) birthdate; 

(5) pre\ious admissions to any state facility; 

(6) name, address and telephone number of 
the legally responsible person or, if there 
is no legally responsible person, the mi- 
nor's next of kin; 

(7) any medical problems, including pertinent 
laboratory data and treatment; 

(8) current psychiatric and other medications; 

(9) history of compliance with medications 
and after care instructions; 

(10) alternatives attempted or considered prior 
to referral to hospit;il; 

(11) goal of hospitalization specifying the 
treatment problem(s) that the hospital 
should address; 

(12) specific suggestions for programming and 
other treatment planning recommen- 
dations; and 

(13) release plans to mclude the information 
relevant to placement and other special 
considerations of the client upon dis- 
charge from the hospital. 

(c) The wntten info nnat ion shall accompany 
the minor to the hospital. 

Statutorv Authoritv G.S. I22C-22I through 
I22C-223: I22C-26I: I22C-262; I43B-147. 

.0215 WRITTEN AGRKtMENTS/NON-SINGI.E 
F'ORTAL .AREAS 

(a) In a non-single portal area, when a licensed 
physician or eligible ps\chologist who is not af- 
filiated with the area program makes a referral of 
a minor for hospital admission, he shall be asked 
by the hospital unit to sign a written agreement 
which promises the following; 

(1) continued involvement with the 
child family during hospital treatment; 

(2) participation m identification and coordi- 
nation of community services that are es- 
sential to discharge planning; and 

(3) provision of ai~tercare, as needed, following 
discharge. 



(b) The purpose of this written agreement is to 
assure that appropriate planning for treatment, 
discharge and aftercare will occur. 

(c) If the referring agent does not sign the 
agreement described in Paragraph (a) of this 
Rule, the hospital staff shall consult with the 
minor's legally responsible person to determine 
his choice of a practitioner to participate in dis- 
charge and aftercare planning. The designated 
person shall thereafter be called the referring 
agent. 

(1) If the legally responsible person names a 
practitioner, the hospital staff shall obtain 
the legally responsible person's written 
consent to contact the practitioner chosen 
in order to request the practitioner's par- 
ticipation in discharge and aftercare plan- 
ning. 

(2) If the legally responsible person does not 
know of a practitioner, the hospital staff 
shall suggest the child and youth coordi- 
nator in the area program in the catch- 
ment area where the minor resides. The 
hospital staff shall obtain the legally re- 
sponsible person's written consent to 
contact the child and youth coordinator 
and shall request the child and youth co- 
ordinator's participation in discharge and 
aftercare planning. 

(3) If the legally responsible person does not 
know of a practitioner and declines to 
choose the child and youth coordinator, 
the hospital stalf may suggest other prac- 
titioners. If the legally responsible person 
selects a practitioner other than the child 
and youth coordinator, the hospital staff 
shall proceed as described in Subpara- 
graph (c)(1) of this Rule. 

(4) If the legally responsible person refuses to 
permit the involvement of any practitioner 
in discharge and aftercare planning or re- 
fuses to sign the wntten consent described 
in Subparagraph (c)(1) or (c)(2) of this 
Rule, and in the opinion of the responsi- 
ble professional, such refusal would be 
detrimental to the minor, the responsible 
professional shall so state in writing, and 
thereafter, the hospital staff shall so advise 
the child and youth coordinator in the 
area program in the catchment area where 
the minor resides. 

Siatutorv Authoritv G.S. I22C-222: I22C-26I; 
/ 433-/47. 

.0216 INFORMATION FOR TREATMENT 
PLANNING 



93S 



NORTH CAROLISA REGISTER 



PROPOSED RULES 



(a) The referring agent shall send the following 
client information, if available, to the appropriate 
hospital admissions office within three working 
days following the minor's admission or com- 
mitment to the hospital. This information shall 
include but not be Umited to the following: 

(1) family history, current composition, cur- 
rent functioning, and motivation for 
treatment; 

(2) child/youth's developmental history, hi- 
ghest level of functioning in the past, and 
current level of functioning; 

(3) relationship with family, peers and others; 

(4) personality characteristics and degree of 
emotional and/or organic impairment; 

(5) how, and, under what circumstances, the 
impairment is most manifest; 

(6) intellectual level, past and current; 

(7) educational-academic functioning, and 
school history; 

(8) strengths, individual and family; 

(9) long range planning; and 
(10) goals for hospitalization. 

(b) The information required in Paragraph (a) 
of this Rule shall be used by hospital staff in de- 
veloping the treatment plan. 

Statuuny Authority G.S. l22C-55(a): I43B-I47. 

.0217 NOTIFICATION BY llOSPIT.\L OF 
ADMISSION/DENIAL 

(a) The child and youth unit director shall no- 
tify the referring agent within 24 hours regarding 
the foUowing: 

(1) the decision to admit the minor and the 
admission date; or 

(2) the decision to deny admission of the mi- 
nor, including the reasons for the denial 
and any recommendations for treatment 
altemati\'es. 

(b) In those instances where the individual has 
not been referred by an area program, the hospi- 
tal shall notify the referring agent and the appro- 
priate area program in a timely manner regarding 
the hospital's decision to admit or deny admis- 
sion to the individual. 



(3) expectations regarding family involvement; 

(4) expectations regarding area program and 
other community agency involvement; 

(5) dates of hospital diagnostic/treatment 
conference; and 

(6) dates of discharge planning conference. 
The information in Paragraphs (5) and (6) in this 
Rule should be provided as early as possible to 
aUow for referring agent participation. 

(b) The child and youth unit director shall no- 
tify the referring agent concerning any significant 
changes in the minor's treatment plan. 



Statutory AuthorUv 
l22C-55(a); I43B-I47. 



G.S. 122C-53(a); 



.0219 ONGOING INFORMATION PROVIDED 
BY REFERRING AGENT 

During the minor's hospitalization, the referring 
agent shall keep the child and youth unit director 
informed regarding the following: 

(1) availability of appropriate community re- 
sources; 

(2) relevant information pertaining to 
community's/family's change in circum- 
stances; 

(3) abnity of other agencies to participate with 
treatment; and 

(4) relevant educational material to aid hospital 
in educational planning as provided by the 
school system. 



Statutory Authority 
122C-55(a); I43B-I47. 



G.S. l22C-53(a): 



.0220 FAILURE OF AREA PROGRAM TO 
PARTICIPATE IN PLANNING 

If the referring agent is the area program, and 
the area program fails to participate in planning 
for the treatment, discharge and aftercare of the 
minor, the child and youth unit director shall 
notify the child and youth coordinator. If ap- 
propriate area program participation does not 
occur after such notification, the child and youth 
unit director shall notify the area director, and 
then, if necessary, the regional child and family 
coordinator. 



Statutory A uthority 
l22C-55(a): I43B-I47. 



G.S. l22C-53(a): Statutory Authority G.S. I22C-221; 143B-I47. 



.0218 SHARING OF INFORMATION WITH 
REFERRING AGENT 

(a) During the formulation of the minor's 
treatment plan, the child and youth unit director 
shall share the following information with the 
referring agent: 

( 1) goals for hospitalization; 

(2j anticipated length of stay; 



.0221 EMERGENCY INVOLUNTARY 
COMMITMENT 

(a) Any minor who meets criteria for inpatient 
commitment pursuant to G.S. 122C-262 shall be 
admitted to the child and youth unit whether or 
not the minor has been screened by a referring 
agent. 

(b) In those instances where the minor has 
been committed without screening by a referring 



NORTH CAROLINA REGISTER 



939 



PROPOSED RULES 



agent, the hospital shall notify, within one work- 
ing day, the area program in the catchment area 
w here the minor resides of the emergency com- 
mitment. 

Statuton> Authority G.S. I22C-262: I43B-147. 

.0222 FMKKGKNC^ ADMISSION/ 
COMMIIMKMS AND BF.D 
WAILAHILITY 

(a) When a minor has been admitted to a hos- 
pital in accordance with Rule .0208(b) of this 
Section and no bed is available in the child and 
youth unit, the hospital and the area program in 
the catchment area where the minor resides shall 
make every effort to locate an alternate place- 
ment. If no other placement is available, the 
child shall be admitted to the hospital and placed 
in the most appropriate available bed. 

(b) Wlicn a mmor has been committed to a 
hospital in accordance with Rule .0221 of this 
Section and no bed is available in the child and 
youth unit, the hospital and either the referring 
agent, if the minor has been screened, or the area 
program in the catcluncnt area where the minor 
resides, if the minor has not been screened, shall 
make evePv' effort to locate an alternative place- 
ment. If no other placement is available the child 
shall be admitted to the hospital and placed in 
the most appropriate available bed. 



Statuton' Authority G.S. 
I43B-147. 



I22C-223: 122C-262: 



.022.1 (ASK mana(;kmknt for 

I NSCKKKNFD FMFKGKNCV 

co^F\HTME^^s 

(a) In those mstances where the mmor has not 
been screened by a referring agent pnor to emer- 
gency commitment to a hospital, the area pro- 
gram in the catchment area where the minor 
resides shall appoint a case manager for the mi- 
nor within two workmg days of receipt of notifi- 
cation of the commitment. 

(b) The case manager shall promptly commu- 
nicate with the child and youth uiut director or 
his designee to arrange a comprehensive treat- 
ment planning conference. The case manager 
shall also communicate with the hospital child 
and youth unit director or his designee regarding 
discharge planning. 

Statutory .luthority G.S. I22C-262: I43B-I47. 

.0224 DISCIIARGF OF MINOR 

(a) The child and youth unit director shall dis- 
charge a minor from treatment when it is deter- 
mined that the minor is no longer mentally iU or 
no longer in need of treatment at the hospital. 



(bj The minor's legally responsible person may 
file a written request for discharge from the hos- 
pital as specified in G.S. 122C-224.7. 

(c) The child and youth unit director shall no- 
tify the referring agent and the legally responsible 
person as soon as a decision to release the mmor 
from the hospital is made. 

Statutory Authority G.S. I22C-224.7; 1 433- 1 47. 

.0225 DISCHARGE ['FANNING 

Discharge planning shall occur for each minor 
admitted or committed to the hospital. 

Statutory' Authority G.S. I22C-22I: I22C-222; 
I22C-224.7: I43B-I47. 

.0226 PARTICIPANTS IN DISCHARGE 
P FANNING 

(a) The hospital shall consult with the referring 
agent to determine who will participate in dis- 
charge planning. 

(b) In those mstances where there is no refer- 
rmg agent, the case manager appointed pursuant 
to Rule .0223 of this Section shall be consulted 
to determine who will participate. 

(c) If the hospital docs not request the referring 
agent's participation in discharge planning, the 
referring agent shall notify the child and youth 
umt director. 

Statutory Authority G.S. I22C-22I: I22C-222; 
I22C-224.7; 1 43 B- 147. 

.0227 DISCHARGE PF.ANNING AND WRITTEN 
PFAN 

(a) A conference shall be held to formulate a 
discharge plan for each minor. The planning 
shall include, but not be limited to, the following: 

(1) a review of the minor's presenting prob- 
lems, social circumstances and relevant 
case liistory; 

(2) a discussion of follow-up treatment alter- 
natives based on realistic community al- 
ternatives; and 

(3) the assignment of responsibility(ie5) for 
implementation of the discharge plan. 

(b) A written discharge plan shall be developed 
based on the results of the conference. Copies 
of the plan shall be distributed to relevant parties. 

Statutory Authority G.S. I22C-22I; I22C-222; 
I22C-224.7: I43B-I47. 

.0228 DISCHARGE PLAN IMPLEMENTATION 
FOR AREA PROGRAM RFFERRAFS 

(a) When a minor referred by an area program 
is discharsed. the minor's case manager shall be 



940 



NORTH CAROLISA REGISTER 



PROPOSED RULES 



responsible for supervising the implementation 
of the minor's discharge plan. 

(b) I'hc following staff shall be available to as- 
sist the minor's case manager in implementing 
the minor's discharge plans: 

( 1 ) area program child and youth coordinator; 

(2) child and youth staff; 

(3) other appropriate area program staff; 

(4) area program Willie M. coordinator; and 

(5) regional screening committee. 

Staiuiorv Authority G.S. 122C-22I; I22C-224.7; 
143B-I47. 

cii.vpter 18 - ment.\l fiealtfi: other 
pro(;rams 

subchapter 181 - general 
requirements 

section .0100 - purpose: scope: 
applicability and definitions 

.0115 deemed statis 

A oompouL'nt that- i« oup i 'oyod aR4 cortified hf 
a nationally rooognii'.L'd acoroditation body whoso 
C i tandardr . 1-he commi ;.!. ion acoeptr . » few ef it* 
own -. hall bt* ccmsidorod to be i«- complianc e with 
applicublL * t . tundardo codified i» -W NCi\C -l-Svt 
through IMQ. Ilowovor. tbe di' i ision may review 
such componont ' .i a** it- dooms nocer i sary t» carry 
e«t its fL'uponi i ibilitiijS fof assuring compliance 
with oth e r commission aft4 division rules aft4 
regulations. 

(a) If an inpatient psychiatric ser\ice or inpa- 
tient substance abuse treatment service operated 
by an area program is surveyed and accredited 
by the Joint Commission on Accreditation of 
Healthcare OrLianizations, the commission deems 
the service to be in compliance uith applicable 
rules codified in 10 NC.AC 181 throudi 18g with 
the exception of the following rules: 10 NCAC 
ISI .0114: 1K.I .0213; 18L .0108, 18L .0224, 18L 
.0429, ISL .0431 and, for inpatient substance 
abuse treatment scn.'ices only, 14N .0103(c). 
Any service certified under the pro\isions of the 
rules contained m Hi NCAC 181 through 18Q 
shall, however, continue to be subject to in- 
spection by the division. 

(b) ]f an inpatient psychiatric service or inpa- 
tient substance abuse treatment service is pro- 
\ided on a contractual basis with an area 
program is surveyed and accredited by the Joint 
Commission on Accreditation of 1 lealthcare Or- 
ganizations, the commission deems the service to 
be in compliance with applicable rules codified 
in 10 NCAC 181 through 18Q with the exception 
of the following rules: 10 NCAC 181 .0114; 18J 
.0213; 18K .0263: 181, .0108, 18L .0224, 18L 



.0429, and, for inpatient substance abuse treat- 
ment services only, 14N .0103(c). Anv service 



certified under the provisions of the rules con- 
tained in U) NCAC 181 through 18Q shall, 
however, continue to be subject to inspection by 
the division. 

(c) If a residential service for persons with 
mental retardation or other developmental disa- 
bihties operated by an area program is certified 
as an Intermediate Care FaciJity for the Mentally 
Retarded (ICb MR) b^ the North Carolma Di- 
vision of Facility Services for the Health Care 
Financing Administration of the United States 
Department of Health and Human Services, the 
commission deems the sers'ice to be in compli- 
ance with applicable rules codified in K) NCAC 
181 through 18Q with the exception of the fol- 
lowing rules: 10 NCAC 181 .0114; 18J .0213; 
18L .0108, 18L .0224, 18L .0429 and 18L .0431. 



Any service certified under the provisions of the 
rules contained in ]_0 NCAC 181 through 18Q 
shall, however, continue to be subject to in- 
spection by the division. 

(d) If a residential service for persons with 
mental retardation or other developmental disa- 
bilities is provided on a contractual basis and is 
certified as an Intermediate Care Facihtv for the 
Mentally Retarded (ICF/MR) by the North Ca- 
rolina Division of Facility Services for the Health 
Care Financing Administration of the United 
States Department of Health and Human Ser- 
vices, the commission deems the service to be in 
comphance with applicable rules codified in 10 
NCAC 181 through 18Q with the exception of 
the following rules: 10 NCAC 1_8I .0114; 18J 
.0213; 18K .0263; 18L .0108, 18L .0224, 18L 
.0429, and 18L .0431. Any service certified under 
the provisions of the rules contained in 10 
NCAC 181 through 18Q shall, however, continue 
to be subject to inspection by the division. 

(e) Deemed status may be provided only if the 
program shall agree to provide to the Division 
of Mental Health, Mental Retardation and Sub- 
stance Abuse Services copies of the following 
documents: 

( 1) JCAHO statement of construction and fire 
protection (as submitted to JCAHO by 
the accredited program); 

(2) JCAHO reports and recommendations; 

(3) JCAHO focused sur\'ey reports; 

(4) Accredited program progress reports 
which have been sent to the program by 
JCAHO; and 

(5) Pennission to participate in any regular 
survey conducted by the JCAHO. 

Statutory Authority G.S. I43B-I47. 



NORTH CAROLINA REGISTER 



941 



PROPOSED RULES 



SI BCHAI'TFR 18.1 - AREA PROGRAM 
M AN AGKMKM STANDARDS 

SECTION .0700 - QUALITY ASSLRANCE 

.0709 CROSS-REFERENCE TO CLINICAL 

SLI'ER\ ISION OK SUBSTANCE ABLSE 
STAFF 

(a) For those services not subject to licensure 
under G.S. 122C. Article 2^ clinical supervisif^n 
of substance abuse statT shall be implemented 
according to the pro\'isions of 10 NCAC I4K 
.0319 (b)'(3), (4) and (5). 

(b) For purposes of the rules of this Section, 
the term -facility" in 10 NCAC 14K .0319 shaU 
be interpreted to mean "component". 

Statuion,- Authority (7.5. I43B-I47. 

.0712 CROSS-RFFFRFNCF TO EMPLOYEE 
EDUCATION AND TRAINING 

(a) Each component not subject to licensure 
under GS. 122C. Article 2 shall comply with the 
provisions of 10 NCAC 14K .0307. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0307 shall 
be interpreted to mean "component". 

Statutoiy Authority G.S. 1438-14'^. 

SUBCHAPTER 18L - PROGRAM COMPONENT 
OPER.\TIONAL ST.\NDARDS 

SECTION .0300 - FACILITIES MANAGEMENT 

.O.V^3 CROSS-REFERENCE TO INDOOR 
Ll\ ING SPACE 

Each residential and respite facility not subject 



to licensure under G.S. 122C. .Article 



shall 



comply with the provisions of 10 NCAC 14K 
.0325 (ll, (3). (4) and (8). 

Statutoiy Authority G.S. I43B-I47. 

.0334 CROSS-REFERENCE TO OUTDOOR 
ACTIVITY SPACE/EQUIPMENT 

Each facility not subject to licensure under G.S. 
122C. .Article 2 shall comply with the provisions 
of 10 NCAC 14K .0326. 

Statutory Authority G.S. I43B-I47. 

.0338 CROSS-REFERENCE TO PIHSICAL 
E.\AMS/MEDIC.\L PROCEDL RES 

Components not subject to licensure under G.S. 
122C. .Article 2 perfonning physical examinations 
or medical procedures shall comply with pro- 
visions of 10 NCAC 14K .0340. 

Statutory Authority G.S. 1438-14^. 



SECTION .0400 - CLIENT RIGHTS 

.0429 CROSS-REFERENCE TO COMPLIANCE 
WITH ST.\TUTES 

In addition to G.S. 122C, each component not 
subject to licensure under G.S. 122C, Article 2 
shall implement its services in such a manner as 
to ensure the rights accorded all clients as re- 
quired by the following: 

(1) G.S. 131D-19 through 131D-24 (Domicil 
bi=y- (Domiciliary Home Residents' Bill of 
Rights); 

(2) G.S. 108A-99 through 108A-111 (The 
Protection of the Abused, Neglected or Ex- 
ploited Disabled Adult Act); 

(3) G.S. 7A-542 through 7A-552 (Screening of 
Abuse and Neglect for Juveniles); and 

(4) G.S. 130.A-143 through 130A-148 (Com- 
municable Diseases and Conditions). 

Statutory Authority G.S. 7A-542 through 7A-552: 
I0SA-9Q through lOSA-lll: IISC-Article 9; 
12:C-5I throuith J22C-62; 1 30 A- 143 through 
I30A-14S: 131'D-19 through 13ID-24; I43B-I47. 

.0432 CROSS-REFERENCE TO CLIENT 
GRIEV.\NCE POLICY 

The go\eming body of each component not 
subject to licensure under G.S. 122C, .Article 2 
shall comply with the pro\isions of 10 NCAC 
I4K .0328. ' 

Statutory Authority G.S. 1 43 B- 1 47. 

SECTION .0600 - CLIENT ELIGIBILITY 

.0604 CROSS-REFERENCE TO CLIENT FEE 
FOR SERVICE 

The governing body of each component not 
subject to licensure under G.S. 122C. .Article 2 
shall comply with the pro\isions of 10 NCAC 

i4k; ,0309. ■ 

Statutoty Authority G.S. 122C-146: 1438-147. 

SECTION .0700 - TREATMENT/IIABILITATION 
PROCESS 

.0702 CROSS-REFERENCE TO ADMISSION 

(a) Each component not subject to licensure 
under G.S. 122C. .Article 2 shall comply with the 
provisions of 10 NCAC 14K .0313. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0313 shaU 
be interpreted to mean "component". 

Statutoiy Authority G.S. I43B-I47. 

.0703 CROSS-REFERENCE TO ASSESSMENT 



942 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(a) Each component not subject to licensure 
under G.S. 122C, Article 2 shall comply with the 
provisions of 10 NCAC 14K .0314. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0314 shill 
be interpreted to mean "component". 

Statutory Authority G.S. I43B-I47. 

.0705 CROSS-REFKRENCE TO INDIVIDUAL 
TREAIMEM/PROGRAVl PLAN 

(a) Each program component not subject to 
licensure under G.S. 122C, Article 2 which pro- 
vides active treatment/habilitation shall comply 
with the provisions of 10 NCAC 14K .0315. 

(b) Eor purposes of the rules of this Section, 
the term "facility" m 10 NCAC 14K .0315 slnll 
be interpreted to mean "program component" 

Statutory Authority G.S. I22C-5I: I43B-I47. 

.0706 CROSS-REFERENCE TO DISCHARGE/ 
AFTERCARE 

(a) At discharge, each program component not 
subject to licensure under G.S. 122C, Article 2 
shall comply with the provisions of 10 NCAC 
14K .0316. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0316 shall 
be interpreted to mean "program component". 

Statutory Authority G.S. I43B-I47. 

.0707 CROSS-REFERENCE TO SERVICE 
COORDINATION 

(a) Each program component not subject to 
licensure under G.S. 122C, /Vrticle 2 shall comply 
with the provisions of 10 NCAC 14K .0318. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0318 shall 
be interpreted to mean "program component". 

Statutory Authority G.S. I43B-/47. 

SECTION .0800 - HEALTH PRACTICES 

.0804 CROSS-REFERENCE TO MEDICAL 
EMERGENCIES 

Each The governing body of each component 
not subject to licensure when G.S. 122C, Article 
2 shall comply with the provisions of 10 NCAC 
14K .0335. 

Statutory Authority G.S. I43B-I47. 

.0805 CROSS-RKFERENCE TO EMERGENCY 
INFORMAIION 



(a) Each component not subject to licensure 
under G.S. 122C, Article 2 shall comply with the 
provisions of 10 NCAC 14K .0336. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0336 shaU 
be interpreted to mean "component". 

Statutory Authority G.S. I43B-I47. 

.0806 CROSS-REFERENCE TO EMERGENCY 
CARE PERMISSION 

(a) Upon the client's admission, each compo- 
nent not subject to hcensure under G.S. 122C, 
Article 2 shall comply with the provisions of 10 
NCAC 14K .0337. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0337 shall 
be mterpreted to mean "component". 

Statutory Authority G.S. I43B-I47. 

.0807 CROSS-REFERENCE TO STAFF 
TRAINING FOR MEDICAL 
EMERGENCIES 

(a) Each component not subject to licensure 
under G.S. 122C, Article 2 shall comply with the 
provisions of 10 NCAC 14K .0338. 

(b) For purposes of the rules of this Section, 
the term "facihty" in 10 NCAC 14K .0338 shall 
be interpreted to mean "component". 

Statutory Authority G.S. I43B-I47. 

.0808 CROSS-REFERENCE TO 

RESPONSIBILITY FOR WATER SAFETY 

(a) Each component not subject to licensure 
under G.S. 122C, Article 2 which includes water 
activities in its schedule shall comply with the 
provisions of 10 NCAC 14K .0343. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0343 shaU 
be interpreted to mean "component". 

Statutory Authority G.S. 143B-I47. 

.0809 CROSS-REFERENCE TO FIRST AID 
SUPPLIES 

(a) Each component not subject to licensure 
under G.S. 122C, Article 2 shall comply with the 
provisions of 10 NCAC MK .0341. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0341 shall 
be interpreted to mean "component". 

Statutory Authority G.S. I43B-I47. 

SECTION .0900 - CLINICAL SERVICES 

.0903 CROSS REFERENCE TO SPECIALIZED 



NOR TH CA ROLINA R EG IS TER 



943 



PROPOSED RULES 



THERAPIES 

Specialized therapies provided by programs not 
subject to licensure under Cj S. i22(r, Article 2 
shall be implemented according to the provisions 
of lU NCAC 14K. .0334. 

Slatutoty Authority G.S. I43B-I47. 

.0904 CROSS-REFERENCE TO TESTING 
SERMCES 

Testing ser\'ices pro\ided bv programs not sub- 
ject t£ licensure under (j.S. 122C, Article 2 shall 
be implemented according to the provisions of 
10 NCAC 14K .0345. 

Statutory Authority G.S. I43B-147. 

SECTION .1000 - MEDICAL SERVICES 

.1002 CROSS-REFERENCE TO PHVSICI.\N 
RESPONSIBLE/MEDICAL SERMCES 

I-ach component not subject to licensure under 
G S. 122C. .Article 2 pro\iding medical services 
shall comply with the provisions of 10 NCAC 
14K .0339. 

Statutory .Authority G.S. I43B-I47. 

.1004 CROSS-REFERENCE TO L.\BOR.\TORY 
POLICIES .\ND PROCEDLRES 

(a) The govemmg body of each component not 
subject to licensure under G.S. 122(^ Article 2 
uliich orders laborator.' tests shall comply with 
the provisions of 10 NCAC 14K .0346. 

(b) For purposes of the rules of this Section, 
the term -facility" in 10 NCAC 14K .0346 shaU 
be interpreted to mean "component". 

Statutoiy Authority G.S. I43B-I47. 

.1005 CROSS-REFERENCE TO LABORATORY 
ACCREDITATION 

Each component not subject to licensure under 
G.S. 122C, .Article 2 which orders laboratory- 
tests shall comply with the prosisions of 10 
NCAC 14K .0347'. 

Statutoty Authority G.S. I43B-I47. 

.1006 CROSS-REFERENCE TO 

DOCLMENT.\TION OF LABORATORY 
TESTS 

(a) Each component not subject to licensure 
under (j.S. 122C, .Article 2 shaU comply with the 
provisions of 10 NCAC 14K .0348. 

(b) Eor purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0348 shall 
be interpreted to mean "component". 



Statutory Authority G.S. I43B-I47. 

SECTION .1 100 - MEDICATION SERMCES 

.1 102 CROSS-REFERENCE TO PRESCRIBING 
OF MEDICATION 

(a) Individuals prescribing medication in pro- 
grams not licensed under G.S. 122C, Article 2 
shall comply with the provisions of 10 NCAC 
14K .0349. 

(b) For purposes of the rules of this Section, 
the term "facilities" m 10 NCAC 14K .0349 shall 
be interpreted to mean "services". 

Statutory Authority G.S. 143B-I47. 

.1103 CROSS-REFERENCE TO DISPENSING 
OF MEDICATION 

Individuals dispensing medication in programs 
not hcenscd under G.S. 122C, Article 2 shall 
comply with the provisions of 10 NCAC 14K 

.0350. 

Statutory Authority G.S. 90-IS.l: 90-18.2; 90-68; 
90-85.2; I43B-147. 

.1104 CROSS-REFERENCE TO 

ADMINISTR.VTION OF MEDICATION 

(a) In programs not subject to hcensure under 
G.S. 122C. Article 2^ medication shall be admin- 
istered accordmg to the provisions of 10 NCAC 
14K .0351. 

(b) For purposes of the rules of this Section, 
the term "facilities" in 10 NCAC 14K .0351 shall 
be interpreted to mean "programs" 

Statutory Authority G.S. 90-21.5; 

90-171.20(7), (8); 90-177.44; 143B-I47. 

.1 105 CROSS-REFERENCE TO STORAGE OF 
MEDICATION 

In programs not subject to licensure under G.S. 
122(,\ Article 2, all medication shall be stored 



according to the provisions of 10 NCAC 14K 

.0352. 

Statutory Authority G.S. I43B-I47. 

.1 106 CROSS-REFERENCE TO DISPOSAL 
OF MEDICATION 

(a) In programs not subject to hcensure under 
G.S. 122C, Article Z medication shall be dis- 
posed of accordmg to the provisions of 10 
NCAC 14K .0353. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0353 shall 
be interpreted to mean "program". 

Authority G.S. I43B-I47; 21 C.F.R. 1307.21. 



944 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



.1 107 CROSS-REFERENCE TO MEDICATION 
EDLCATION 

Programs not subject to licensure under G.S. 
122C, Article 2 providing medication for clients 
shall provide medication education according to 
the provisions of 10 NCAC 14K .0354. 

Statutory Authority G.S. I43B-I47. 

SECTION .1200 - NLTRITION/DIETARY 
PRACTICES 

.1203 CROSS-REFERENCE TO NUTRITION 
REQUIREMENTS 

(a) Each program component not subject to 
licensure under G.S. 122C, Article 2 serving 
meals for clients shall comply with the nutrition 
requirements delineated in 10 NCAC 14K .0356. 

(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0356 shall 
be interpreted to mean "program component". 

Statutory Authority G.S. I30A-361: I43B-I47. 

.1204 CROSS-REFERENCE TO MODIFIED 
DIETS 

(a) Each program component not subject to 



licensure under G.S. 122C. 



Article 2 servmg 



meals for clients shall comph' with the require- 
ments for modified diets delineated in 10 NCAC 
14K .0357. 

(b) Eor purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0357 shaU 
be interpreted to mean "program component". 

Statutory Authority G.S. 130A-36I; I43B-I47. 

.1205 CROSS-REFERENCE TO STAFFING 
FOR FOOD SERVICE 

(a) Each program component not subject to 
licensure under G.S. 122C, Article 2 ser\'ing more 
than one meal daily shall comply with the re- 
quirements for staffmg for food ser\'ice and 
maintenance delineated in 10 NCAC 14K .0358. 

(b) For purposes of the rules of this Section, 
the term "facihty" in 10 NCAC 14K .0358 shaU 
be interpreted to mean "program component". 

Statutory Authority G.S. 1438-147. 

.1206 CROSS-REFERENCE TO FOOD 

SERVICE EQUIPMENT AND SPACE 

(a) Each program component not subject to 
licensure under G.S. 122C, Article 2 ser\ing more 
than one meal daily shall comply with the re- 
quirements for food service equipment and space 
delineated in 10 NCAC 14K .0359. 



(b) For purposes of the rules of this Section, 
the term "facility" in 10 NCAC 14K .0359 shaU 
be interpreted to mean "program component". 

Statutory Authority G.S. 1438-147. 

SECTION .1300 - TRANSPORTATION 
SERVICES 

.1302 CROSS-REFERENCE TO 

TRANSPORl ATION POLICY 

(a) The governing body of each component not 
subject to licensure under G.S. 122C, Article 2 
providing transportation ser\'ices for clients shall 
comply with the requirements regarding trans- 
portation policy delineated in 10 NCAC 14K 
.0361. 

(b) For purposes of the rules of this Section, 
the term "facility" m 10 NCAC 14K .0361 shaU 
be interpreted to mean "component". 

Statutory Authority G.S. 1438-147. 

.1303 CROSS-REFERENCE TO LICENSED 
DRIVER 

Each driver in the transportation ser\'ice in 
program components not subject to licensure 
under G.S. 122C. Article 2 shall comph' with the 
provisions of 10 NCAC 14K .0362. 

Statutory Authority G.S. 1438-147. 

.1304 CROSS-REFERENCE TO SAFETY 
PRECAUTIONS 

Each component not subject to licensure under 
G.S. 122C, Article 2 providing transportation 
services for clients shall comply with the require- 
ments for seat belts and secure storage delineated 
in 10 NCAC 14K .0363. 

Statutory Authority G.S. 1438-147. 

.1305 CROSS-REFERENCE TO 

TRANSPORTATION OF MINORS 

Each component not subject to licensure under 
G.S. 122C, /Vrticle 2 providing transportation 
ser\'ices for minor chents shall comply with the 
provisions of 10 NCAC 14K .0364. 

Statutory Authority G.S. 1438-147. 

SECTION .1400 - RESEARCH PRACTICES 

.1402 CROSS-REFERENCE TO RESEARCH 
REMEVV BOARD 

(a) Each component not subject to licensure 
under G.S. 122C, /Vrticle 2 which involves area 
program clients in research activities shall comply 
with the requirements relating to research review 
boards delineated in 10 NCAC 14K .0333. 



NORTH CAROLINA REGISTER 



945 



PROPOSED RULES 



(b) lor purposes of the rules of tliis Section, 
the term "facility" in 10 NCAC 14K .0333 shall 
be interpreted to mean "component". 

Staiuiory Auihority G.S. I22C-52: 1 43 B- 1 47. 

.140.^ CKOSS-RFFF.RKNCE TO SUBJECT 
I'ARIK II'ATION 

IZach component not subject to licensure under 
G.S. 122C. .Article 2 which in\'ohes area program 
clients in research activities shall comply with the 
requirements for subject participation delineated 
m 10 NCAC 14K .0334. 

Staiuloty Auihority G.S. /22C-52; I43B-I47. 

SI HCIIAI'IKK 18Q - OPTIONAL SERVICES 

KOR INHIMDl ALS WHO ARE MENTALLY 

RETARDED 

SECTION .0200 - BEFORE/AFTER SCHOOL 

AND SI MMFK DE\ ELOPMEN lAL DAY 

SER\ K ES FOR CHII DREN Willi MENTAL 

REI ARDAIION OR OIIIER DE\ ELOPMENTAL 

DISABILITIES 

.0284 CROSS-REFERENCE TO 
INTRODLCTION 

Before after school and summer developmental 
day services not subject to Licensure under (j.S. 
122C. .Article 2 shall eompK" with the provisions 
NCAC 14M 



ot 



.0501 



Slatutory Authority G.S. 1 433- 1 47. 

.0286 CROSS-REFERENCE TO HOURS OF 
OPERAIION 

Before/after school and summer developmental 
day services n(^t subject to licensure under G.S. 
122C. .Article 2 shall comply with the hours of 
operation requirements delineated in 10 NCAC 
14\1 .0502. 

Statutory Authority G.S. 1 438- 147. 

SECTION .0500 - COMMUNITY RESPITE 
SERMCES FOR INDIMDUALS \VI III MENTAL 

RET.\RDATION: OTHER DEVELOPMENTAL 

DISABILITIES: DE\ ELOPMENTAL DELAYS OR 

AT RISK FOR THESE CONDITIONS 

.0521 CROSS-REFERENCE TO POPULATION 
SERVED 

Each community respite ser\'ice not subject to 
licensure imder (j.S. 122(.\ Article 2 shall compK' 
with the provisions of 10 NCAC 14.M .0702. 

Statutory .Authority G.S. I43B-I47. 

SECTION .0700 - (VROUP HOMES FOR 
ADL'LTS VMIO ARE MENFALLY RETARDED 



.0709 CROSS REFERENCE TO 
INTRODUCTION 

Each group home which is not subject to licen- 
sure under G.S. 122C, Article 2 shall comply 
with the requirements set forth in 10 NCAC 14M 
.0301. 

Statutory Authority G.S. I43B-I47. 

.0710 POPULATION SER\ ED 

(a) Each group home shall be designed prima- 
rily to serve mentally retarded or otherwise de- 
velopmentally disabled individuals who are at 
least 1 8 years of age and who are in need of a 
supervised living environment within a commu- 
nity setting. 

(b) No group home shall designate any bed for 
the continuous provision of respite services. 

Statutory Authority G.S. I43B-I47. 

.071 1 HOURS OF OPERATION 

Each group home shall operate 24 hours per 
day, seven days per week, 12 months per year 
unless there are times when all chents are out of 
the home for a period of 24 hours or more. 

Statutory Authority G.S. I43B-I47. 

.0712 ADMISSION DECISION OF CLIENT/ 
LECALLV RESPONSIBLE PERSON 

The client or his legally responsible person shall 
make the final decision as to whether to accept 
the group home placement should the client be 
accepted for admission. 

Statutory Authority G.S. I43B-I47. 

.071.1 C ROSS-REFERENCE TO MANAGING 
CLIENTS' FUNDS 

(a) Each group home which is not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the requirements set forth in 10 NCAC 14K 
.0311. 

(b) Each client, when necessary, shall be pro- 
vitled training in money management. 

Statutory Authority G.S. I43B-I47. 

.0714 ANNUAL INTERNAL ASSESSMENT 

rhe group home program staff shaU conduct an 
annual internal assessment of the program, in- 
cluding the degree of its comphance with the 
standards, and shall develop a written plan of 
action that addresses the correction of each iden- 
tified deficiency. 

Statutory Authority G.S. I43B-I47. 



946 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



.0715 CROSS-REFKRENCE TO COMPLIANCE 
Wn M GROLP HOME STANDARDS 

Each group home, as appropriate, which is not 
subject to hcensure under G.S. 122C, Article 2 
shall comply with the requirements set forth in 
10 NCAC 14M .0303. 

Statutory Authority G.S. I43B-I47. 

SECTION .0800 - APARTMENT LIVING 

PROGRAMS FOR ADl LTS WITH MENTAL 

RETARDATION OR OTHER DEVELOPMENTAL 

DISABILITIES 

.0803 CROSS-REFERENCE TO PROGRAM 
DIRECTOR/COORDINATOR 

Each apartment living program not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the staffing requirements for program 
director coordinator delineated in 10 NCAC 140 
.0204. 

Statutory Authority G.S. 1438- 147. 

.0804 CROSS-REFERENCE TO STAFF 

REQLIRED FOR MR/DD CLIENTS 

Each apartment living program not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the staff/client ratios delineated in 10 NCAC 
140 .0210. 

Statutory Authority G.S. 1 43 B- 147. 

.0808 CROSS-REFERENCE TO TREATMENT/ 
IIABILITATION PLAN 

Each apartment living program not subject to 
licensure under G.S. 122C. Article 2 shall comply 
with the requirements regarding the 
treatmcnt/habilitation plan delineated in 10 
NCAC 140 .0207. 

Statutory Authority G.S. 1 438- 1 47. 

.0810 CROSS-REFERENCE TO CLIENT 

TRAINING IN HEALTH AND SAFETY 

Each apartment living program not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the requirements regarding chent training in 
health and safety deUneated in 10 NCAC 140 
.0209. 

Statutory Authority G.S. 1438-147. 

.0812 CROSS-REFERENCE TO MANAGING 
CLIENTS' FLNDS 

Each apartment living program not subject to 
licensure under G.S. 122C, Article 2 shall comply 
with the requirements regarding managing cli- 
ents' funds delineated 



Statutory Authority G.S. 1 43 B-/ 47. 

SUBCHAPTER I8R - LICENSURE RULES FOR 

MENTAL HEALTH: MENTAL RETARDATION 

AND ALCOHOL FACILITIES 

SECTION .0200 - APPLICATION FOR LICENSE 

.0205 LICENSURE SURVEYS AND ISSUANCE 
(REPEALED) 

Statutory Authority G.S. I22C-26; 1438-147. 

CHAPTER 45 - NORTH CAROLINA DRUG 
COMMISSION 

SUBCHAPTER 45G - MANUFACTURERS: 

DISTRIBUTORS: DISPENSERS AND 

RESEARCHERS OF CONTROLLED 

SUBSTANCES 

SECTION .0100 - REGISTRATION OF 

MANUFACTURERS: DISTRIBUTORS: AND 

DISPENSERS OF CONTROLLED SUBSTANCES 

.0110 TIME FOR APPLICATION FOR 

REGISTRATION: EXPIRATION DATE 

(c) AH- rogiotration ' j L i hull oxpiro »» October ^4-r 
if t4*e r e ui ' jtrant registers within t4*« thr ee monthH 
procoding October rJ4-r A* rugiatration f . hall h*4 
oxpiro until ^^ foUo' i ' i ing Ootobor 3-1^ \ft aU 
other caoes, th« registration shall e xpir e »» Ae 
fifst- October ^ followmg th# date eft ' . ' ■ 'hich tb» 
person regist e red. 

All registrations shall expire annually on the an- 
niversary of their date of inception as hereafter 
set out. I 'or the purposes of these registrations, 
the state shall be divided into a Northern^ Cen- 



tral, and Southern Region. The counties which 
are included in each of these regions are specified 
in Paragraph (d) of this Rule. The date of expi- 
ration for each registration shall be determined 
by the region of the state in which the registrant 
is located. The registrations from the Northern 
Region shall expire on October 31 of each year. 
The registrations from the Central Region shall 
expire on December 3 1 of each year. The regis- 
trations from the Southern Region shall expire 
on July 3 1 of each year. If the registrant registers 
within the three months preceding the expiration 
date for their region, the registration which they 
receive shall not expire until the expiration date 
of the following year. Howe\er, for the registra- 
tion year of 1989 all renewal registrations shall 
be handled in accordance with Paragraph (e) of 
this Rule. 

(d) The counties of the State of North Carolina 
are divided into three regions as follows; 



NORTH CAROLINA REGISTER 



947 



PROPOSED RULES 



( 1) The Northern Reinon shall include the 
tdllouinu counties: Alamance: Allciihanv: 



Ashe: Bertie; ( aiinlen; ("asuell; Chowa n: 
Cumtuck: Dare: Durham: l-dt;ecombe; 
l-orsslh; I'ranklin; (jates; Cjran\ille; 
(juillord, Halifax: Hertford: Martin; Nash; 
Northampton; Oraniie; Pasquotank: Per- 
quimans; Person: Rockindiam; Stokes; 
Sum': Ivrrell; \'ance; Warren; Washing- 
ton; Watauiia: Wilkes: and Yadkin. 
(2) The Central Reaon shall include the fol- 
lowiniz counties: Alexander: A\er\: Beau- 



fort^ Buncomhe; Burke; Calduell: 
Carteret; Catawba: Chatham: Cherokee; 
Cla\ : Cra\en: Da\'idson; DaMc: (iraham; 
(jrecne: Hawvood: 1 hde; Iredell; Jackson: 
Johnston: Jones; I enoir; Macon: Madi- 



son: McDowell; Mitchell: Pamlico; Pitt; 
Randolph: Rowan: S\s'ain: Wake: Wa\ne; 
Wilson: and Vancev_ 
(3) The Southern Reeion shall include the 
followins counties: Anson; Bladen: Brun- 



swick: ('abarrus: C'kn'eland: ("olumbus; 



Cumberland: Duplin; (jaston; Harnett: 
1 lenderson: Hoke: 1 ee; I incoln; Meck- 
lenbum: Monteomen. : Moore; New 
1 lano\er; Onslow: Pender; Polk: Rich- 
mond: Robeson; Rutherford: Sampson; 
Scotland; StanlcN": IransNlvania; and Un- 
ion, 
(e) All renewal rcLgstrations appUed for on 

October 31 . I'^X') shall be uanted in accordance 

with the following! specifications: 

( 1 ) The renewal registratitins received from 
the Northern Region shall be granted for 
the penod of October 31. NS'^) until Oc- 
tober 3b PMO. 

(2) The renewal registrations received from 
the Central Region shall be extended until 



December 31. I'JX^) at which time they 
will be granted for the period of December 
31. P)SQ until December 31. Vm^ 
(3) [he renewal registrations received from 
the Southern Region shall be granted for 
the penod of October 31. P^S^) until July 
31, IWO. 



Statutory Authoritv G.S. 90-100: 1438-120(9). 



is-k-k-k-k-k-k-k-k-k-k-k-k-k-k-k-k-k 



No 



otice is hereby gh'cn in accordance with G.S. 
I SOB- 1 2 that the Department of Human Re- 
source.'; - Dhision of Scnices for the Blind intends 
to amend nde(s) cited as 10 SCAC 19C .0702; 
I9H .0106. 



1 he proposed effective date of this action is June 
I. 1989. 

1 he public hearing will be conducted at 10:00 
a.m. on March II, 1989 at DSB Conference 
Room, Fisher Building, Governor Morehead 
Campus, 309 Ashe Avenue, Raleigh, N.C. 27606. 

(^ omment Procedures: A ny interested person 
may present hisjher comments either in writing 
three days prior to or at the hearing or orally at 
the hearing for a maximum of ten minutes. Any 
person may request information by writing or 
calling Mr. Herman Gruber, Designee, Driision 
of Services for the Blind, 309 Ashe Ave., Raleigh, 
\.C. (919) 733-9822. 

CHAPTER 19 - SERVICES FOR THE BLIND 

SUBCHAPTER 19C - BLSINESS ENTERPRISES 
PROGRAM 

SECTION .0700 - EARNINGS: FUNDS: AND 
PROCEEDS 

.0702 SET-ASIDE 

(b) The di%ision will set aside no more than a 
total of twenty percent of the funds from the net 
proceeds of each stand operation to be used for 
the following purposes; 

F ' jtimutod 
PeroontQno 



( 1 ) maintenance and replacement 
of equipment; 

(2) purchase of new equipment; 

(3) management services; 

(4) assunng a fair minimum return 
to operators; 

(5) 



3.9ir„ 
i.35rB 

7.39r„ 
-1.35% 



the operators may use part of the set-aside 
for the establishment and maintenance of 
retirement or pension funds, health insur- 
ance contributions, and provisions for 
paid sick leave and vacation time, if it is 
so determined by a majority vote of blind 
operators Licensed by the division, after 
the di\ision provides to each operator m- 
formation on all matters relevant to the 
proposed purposes. 
The percentage, to be determined in advance, 
win vary from facility to facility depending upon 
the nature and scope of the accounting services 
rendered by the Disision of Services for the Blind 
to the mdi\idual facility. 



948 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Authority G.S. 1 1 1-12.5; 111-27; 34 C.F.R. 
395.8; 34 C.F.R. 395.9; 20 U.S.C. sec. I07a et 
seq., as amended. 

SUBCHAPTER 19H - MEDICAL/EYE CARE 
PROGRAM 

SECTION .0100 - CERTIFICATION 

.0106 REDETERMINATION 

(a^ A redetermination of eligibility is mandatory 
every six months because of possible changes in 
economic circumstances. 

fb) Rodotormination is unnocoosar/ within » 
ma)dmum 34 month poriod if th« client is ««- 
dorgoing a r . pi^cific troatmont rogimon which is 
inoomploto at- tfee eft4 ©f the si* month poriod. 
Tl*e oovorod oon'iooo witt be Limitod te thos e ift 
the regimon. 

Statutory .4uthority G.S. 1 1 1-8; 143B-I57. 

■k-k-k-k-k-k-k-k-k^-k-k-k-k-k*** 



iS otice is hereby given in accordance with G.S. 
I50B-I2 that the Social Services Commission in- 
tends to amend rule(s) cited as 10 NCAC 27 
.0009; and adopt JO NCAC 42C .2007. 

1 he proposed effective date of this action is May 
I. I9S9. 

1 he public hearing will be conducted at 10:00 
a.m. on February 15, 1989 at Disability Determi- 
nation Services' Building, Conference Room, 321 
Chapanoke Road, Raleigh, N.C. 



Cc 



■ omment Procedures: Any interested person 
may present his/her views and comments either in 
writing or orally at the hearing. Any person may 
request information, permission to be heard or 
copies of the proposed regulations by writing or 
calling Bonnie Allred, 325 N. Salisbury Street, 
Raleigh, NC 27611, (919) 733-3055. 

CHAPTER 27 - CHILD SUPPORT 
ENFORCEMENT 

.0009 HEARINGS AS MANDATED BY THE 
SET-OFF DEBT COLLECTION ACT 

Counties adhere to the following procedures; 

( 1 ) Within 30 days of roooipt ef tl*<* notioo the 
date of mailing of proposed set-off action, 
an absent parent may request a hearing; 
This request shall be in writing and mailed 
or delivered to the address set forth in the 
notice; 



(2) If the county which is responsible for 
management of the absent parent's case is 
has a county-operated IV- D program, then 
the hearing shall be conducted by ih<d diroo 
tef ef A» local IV D program sf local de- 

ftet- b» that individual who was primarily 
rooponoiblo fof handling the ease ift quoo 
tion; a hearing officer designated by the Di- 
rector of the Division of Social Ser\-ices; 

(3) If the county which is responsible for 
management of the absent parent's case is 
has a state-operated IV- D program, tbeft the 
h e aring shall be oonductod by aft individual 
dosignatod by tlw regional IV D consultant; 
the Office of Administrative Hearings shall 
conduct the hearing and the hearing proce- 
dures specified in Chapter 150B, Article 3 
and 26 NCAC Chapter 3 shall apply; 

(4) The hearing shall be conducted at the local 
IV-D agency in the county which is respon- 
sible for management of the case whenever 
feasible or other suitable location as desig- 
nated by the hearing officer; 

(5) AH hearings under this Rule and under G.S. 
105A-8, the Set-Off Debt Collection Act, 
shall be conducted in accordance with G.S. 
44©A7 G^ 15QB, Article 3, the Admimstra- 
tive Procedure Act, and 10 NCAC IB .0200, 
or 26 NCAC Chapter 3 as appropriate. 



Statutory 
143B-I53. 



Authority G.S. 105A-8; 110-128; 



CHAPTER 42 



INDIVIDUAL AND FAMILY 
SUPPORT 



SUBCHAPTER 42C - LICENSING OF FAMILY 
CARE HOMES 

SECTION .2000 - PERSONNEL 

.2007 QUALIFICATIONS OF PERSONAL 
CARE STAFF 

(a) Each aide, administrator, and supervisor- 
in-charge, who provides personal care to resi- 
dents in family care homes and homes for the 
aged and disabled, who is hired after January I, 
1990 to work in a home and who does not have 
six months experience shall have successfully 
completed an aide training program approved by 
the Department of Human Resources, Domicili- 
ary Home Personnel Policies Review Commit- 
tee. \\Tien an individual has not already 
successfully completed an approved aide training 
program, he/she shall enroll in the first available 
approved aide training program which is sched- 
uled to commence within 60 days of the date of 
his/her employment. The program may be es- 



NORTH CAROLINA REGISTER 



949 



PROPOSED RULES 



tablishcd by the home or by an organization or 
educational institution and taught by the admin- 
istrator, supcrvisor-in-charge, other qualified 
staff, or by an organization or educational insti- 
tution. The licensed home shall provide a 
planned orientation within the first week of em- 
ployment for all personal care staff hired after 
January 1, 1989 emphasizing resident care poli- 
cies and procedures, the home's philosophy and 
goals, and staff performance expectations. 

(b) The aide training program shall consist of 
at least the following: 

(1) Twenty hours of classroom instruction to 
commence within 60 days of employment. 
The instruction shall include the individ- 
ual's duties, basic personal care skills, res- 
ident safety and rights, the social and 
psychological aspects of aging, interaction 
with farmhes, the importance of activities 
and social services, and death and dying. 
The 20 hours of classroom instruction 
shall be completed within the first 120 
days of employment. 

(2) Forty hours of supervised training. These 
hours shall consist of an appropnatcly 
supervised work assignment and shall 
commence upon employment. The 40 
hours of supervised training shall be 
completed within the first 120 days of 
employment. 

(3) Proof of successful completion of training 
shall be retained in the home's records, 
and shall be available for inspection. 

Statutory Authority G.S. I3ID-2: I43B-I53. 

■k'k-k-k-k-k-k-kiK-k-k'k-k^'k'k-k'k 



No 



otice is hereby given in accordance with G.S. 
1 SOB- 12 that the Social Services Commission in- 
tends to amend rule(s) cited as 10 NCAC 35D 
.0301. .0304: 35E .0101. .0105, .0106; 35F .0001 
- .0007: 47 B .0404: adopt 10 NCAC 35E .0204: 
and repeal 10 S'CAC 35F .0009. 

1 he proposed effective date of this action is July 
1. 19S9. 

I he public hearing will be conducted at 10:00 
a.m. on February 15, 1989 at Disability Determi- 
nation Services' Building. Conference Room. 321 
Chapanoke Road, Raleigh. \.C. 



Co 



'Ommcnt Procedures: Any interested person 
may present his her vinvs and comments either in 
writing or orally at the hearing, .-iny person may 



request information, permission to be heard or 
copies of the proposed regulations by writing or 
calling Bonnie Allred, 325 .V. Salisbury Street, 
Raleigh, NC 27611. (919) 733-3055. 

CHAPTER 35 - FAMILY SERVICES 

SLBCIIAPTER 35D - CONDITIONS FOR 
PROVISION OF SERVICES 

SECTION .0300 - ELIGIBILITY 
DETERMINATION AND REDETERMINATION 

.0301 ELIGIBILITY DETERMINATION 

(a) An eligibility determination means a deci- 
sion pursuant to an application for social services 
which is based on an assessment of certified and, 
il~ required, verified information necessary to de- 
termine whether an individual meets the condi- 
tions of ehgibility for the ser\ice(s) requested. 
Conditions of eligibility include basic eligibLlity 
criteria applicable to the program or funding 
source under which the service is made available 
and oop i ioo opocifio e ligibility crit e ria, if aftVr af>- 
pli cabl e t& A# conditions of need specified in the 
target population for the service requested, as set 
forth m 10 NCAC 35 through 37 and 10 NCAC 
41 tlirough 42. Procedures for applying eligibility 
catena in order to reach an eligibility decision are 
set forth in the Family Services Manual, as de- 
scnbed in 10 NCAC 35A .0003. 

Statutory Authority G.S. 143B-I53. 

.0304 REDETERMINATION OF ELIGIBILITY 

(a) In order to provide Child Day Care services 
or the federally funded abortion resource item of 
I lealth Support sen,'ices, eligibility must be rede- 
termined on a routine basis of at least every 12 
months or when required on the basis of new 
information provided to the agency about actual 
changes in the client's circumstances that affect 
his eligibility. 

(b) Notwithstanding Paragraph (a) of this 
Rule, eligibility for services provided on the basis 
of need and without regard to income or under 
the Child Welfare Act is based on need and, as 
provided in the Act, services shall continue until 
determined no longer appropnate. 

Statutory Authority G.S. 143B-153. 

SLBCIIAPTER 35E - SOCIAL SERVICES BLOCK 
GRANT (Til IE .\X) 

SECTION .0100 - CONDITIONS OF 
ELIGIBILITY 

.0101 B.\SIC ELIGIBILITY CRITERIA 



950 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



In addition to the requirements of 10 NCAC 
35D .0300, in order for an individual to be de- 
termined eligible to receive services funded under 
the Social Services Block Grant (Title XX), it 
must be established that he is eligible 

fl4 eft the bai . ifi t»f income maintenanc e otatus; 

f i F tTTT rTT^ TTCTTt^ \J I rTTCTTTTTC t it EJ T. TV ^TTTTTTTTy t* 1 1 1 II 1 1 

t4*e maximum income leveh . fof particular 
oor i 'ioor i ; ef 

without regard te inccmio. 
on the basis of need as specified in the target 
population for the servicc(s) requested as set 
forth in 10 NCAC 35 through 37 and 10 NCAC 
41 through 42 except that for purposes of pro- 
viding child day care ser\'ices or the federally 
funded abortion and stcrili/ation resource items 
of I lealth Support Ser\'iccs, eligibility must also 
be determined on the basis of his income main- 
tenance or income clieible status. 



Statutory Authority G.S. I43B-I53. 

.0105 \1 AXIMLM INCOME LEVELS FOR 
SERVICES 

(a) Sixty Percent of Established Income. An 
individual whose gross monthly family income is 
less than 60 percent of the state's established in- 
come for a family of that size may be eligible for 
aft¥ f i UP i ice child day care services or federally 
funded abortion and stcrili/.ation resource items 
of health support scn,'ices funded under the So- 
cial Services Block Grant (Title XX) that » 
available in the county in which he lives. 

(b) I'"ighty Percent of Fstablished Income. An 
individual whose gross montlily family income is 
as much as 60 percent but less than 80 percent 
of the state's established income for a family of 
that size may be eligible for afty ef the following 
ser i 'icoo ser\'ice or resource items if available in 
the county in which he lives; 

(1) community lising seP i icoo; child day care 
ser\-ices; and 

(2) 4ay eafe r .e n'ices fof adulto; federally 
funded abortion and sterilization resource 
items of health support services. 

d e linqu e ncy pr e vention i ie n ices re - ^iden 

health support sop i icoi i ronouroe itemc; 



f4) housing aft4 homo improvement oop i 'Ioog; 
f6-^ iji home senices: chore sen-ices; 
(t^ in home sers'lces: homemaker sorsicoo; 
f^ p e rsonal aft4 family counseling; 
fJ^ preparation aft4 deliv ery f»f meals; 
(+0) residential treatment f»f At* emotionally 
disturb e d. 
(c) One Hundred Percent of Established In- 
come. An individual whose gross monthly fam- 



ily income is as much as 80 percent but docs not 
exceed 100 percent of the state's established in- 
come for a family of that size may be eligible for 
afty &f Ae following sen . 'ices child day care ser- 
vices if it is available in the county in which he 
lives. 

dw eafe seP i ices fef adults; 

in homo sop i icos: chore sep i' icos; 

in hom e sers^icos: homomakor seP i ^iceo; 



w 
^ 
m 
w 



preparation aft4 doli' i ory »f meals 



Statutory Authority G.S. I43B-I53(2a)b. 

.0106 WITHOUT REG.ARD TO INCOME 
STALLS 

fa) Individuals may be determined eligible for 
the following ser\ices on the basis of need for the 
service and without regard to their income: 

(1) adoption services; 

(2) foster care services for adults; 

(3) foster care services for children; 

(4) protective ser\'ices for adults; 

(5) protective ser\ices for children; 

(6) aft¥ s e rvice child day care services and 
funded abortion and sterilization 



federally 
resource 



items of health 
the 



support services 
Social Services Block 



funded under 
Grant (Title XX) that is arc needed in con- 
junction with protective services may be 
provided without regard to income during 
the first 12 months that protective scr\'ices 
is provided if such service is available in the 
county in which the individual hves and the 
agency has received a referral/report pursu- 
ant to G.S. 7A-543 or G.S. 108A, Article 6, 
has initiated protective services in accord- 
ance with program policies, and has deter- 
mined that such other services are needed to 
support the provision of protective services; 

(7) delinquency prevention (excluding (in- 
cluding residential care); 

(8) employment and training support services 
( e xcluding (including transportation and re- 
source items); 

(9) health support services (excluding trans 
poitation aft4 resource items); (including 
transportation and resources for the aging, 
disabled or handicapped but excluding steri- 
lization and abortion resource items); 

(10) individual and family adjustment services 
(excluding (including camping component); 

(11) problem pregnancy (including residential 
care); 

(12) community living ser\-ices; 

( 13) day care ser\'iccs for adults; 

( 14) housing and home impro\ement services 
(including resource items); 

(15) in-home services: chore services; 



NORTH CAROLINA REGISTER 



951 



PROPOSED RULES 



( 16) in-home scn'ices: homemakcr services; 

( 17) personal and family counseling; 

( IS) preparation and deli\'er\' of meals; 

( b)) residential treatment for the emotionally 
disturbed: and 

(20) transportation ser\'ices. 

(4*4 Notwith '. tanding fa^ »f t44s Rule, choro 
L . onict ' i i H»¥ be pro' i idod without regard k» m- 
como k» t ' C's ere ' ly phy >' icully dir i abknl indisiduaJs 
fof puqio 'i L" ! h4 conductinij * dt ' inonf i tration pro 
jet4 H+ Mc ' cklenburi; (jounty. I ' IiIl ' O ' j r i pQcifically 
oxL ' inplL ' d. ail other requirement! , governing At» 
pro' i i ' jion ef chore s e nic e s r . hall be met. ?4t(* 
puq">or ie ei f4+e demonstration projoot i« te pfe- 
molc ' imd- enhance independent living fof oeveroly 
ph> '' ically disabled indi' i idual '. through th<* pro 
' . p . ion t4 clu<re t ' er i ice ' .i. Ir^ demon ' jtration 
project vrttt bi* operated m- accordance vrith pro 
cedurer . eiitabln . hed by t4*t» Department ej Human 
Re '. ource ; " . . Di' i ii i ion t4 Social Senicec, aH4 tb<» 
nisi -. ion t-4 Vocational Rehabilitation. 

fel Notv i ilhi ' tanding fa| t*f t4w?T Rule. a«4 bt>- 
coming eflecti' i e contingent upon federal ap- 
pro' i al (-4 t+w ('onimunity Linkageo Program, 
trail '. portation L i ervie e s Hwy be provided ' ■ ' ■ ithout 
regard te- income fof a penod »»*• te- exceed ftifte 
month ' . I to individuah; v . ho obtain un ' ; . ub ' . . idii'ed 
emplo\ nient v , hile pailicipating m- tbe Commu 
ftrty- I inkagei ' Program fof puquii i eo «4" conduct 
mg: a demonstration project ift iVlamance 
County . 4-be purpo '. e t>f tbe demonotration 
project H to te^t■ a method ef linking t . ervicer i 
availabl e through t4+e jMamance (bounty Depart 
ment t+f Sociiil Service '. , the Alamance Ollice »f 
t4*e limplosinent S e cunty (.'ommiiif ' ion. aH4 ti+e 
I'echnical Coll e g e e4 i\lamance to ai .'. iot recipi 
eftte ©f Ai4 to ramilieo with Dependent Children 
to preporo fofr fioouro asti retain uni . ub ' jidijed 
omplov ment. 54+e demo nr . t rat ion project Vi4tt be 
operated m- accordanc e v . ith procedure ', ei . tab 
li '. hed under fbe authority ei Sootion 1 1 15 ©f Ae 
Social Secunty Act. 

Statutory Authority G.S. I43B-1 53i2a)b. 



Statutory Authority G.S. 143B-I53. 

SLBCll.APTER 3SF - FEES FOR SERVICES 

.0001 GENERAL FEE POLICY 

(a) No fees will be charged for any services 
provided to the following categories of individ- 
uals: 

( 1 ) recipients of aid to families with dependent 
children payments; 

(2) recipients of supplemental security income 
benefits; 

(3) individuals whose famUv gross monthlv 
income is less than 100 percent of the 
state's established income. 

Statutory: Authority G.S. I43B-I53. 

.0002 SKRMCES FOR WHICH FEES ARE 
CHARGED 

fa) Fees may must be charged for the following 
sen,'ices or resource items when these services are 
provided to individuals whose family gross 
monthly income is betw e en 60 p e rcent aR4 4-9© 
percent at or above 100 percent of the state's es- 
tablished income for their family size: 

(1) chore services; 

(2) day care services for adults; 

(3) homemakcr services; 

(4) preparation and delivery of meals; 

(5) housing and home improvement resource 
items; 

(6) personal and family counseling services; and 

(7) transportation services. 

fbf 4-he detennination ef whether fee* are 
charged fof each »f the r . ervices identified m fa-^ 

■ -» 4 t t-n L- U 1 1 I . 1 .- V-t •-> 1 1 V^. t f-\ ^^ . 1 f^ .-» r\ -1 .-• .-1 1 1 «i f 1 ■ \-\ 1 : /-• ■— t i i f-< t i r 
\.' 1 nTTTT XTOTC^ Jl iUD^ I.' I. 1 1 iUUV, TTTT CT l_ !_' U 1 1 1 T L.' f \J^^\Jtx IT. T 

baL . i '. . Whore it- » detenmned that- fees wtli be 
charged. t4*e mcome eligibility range at v i hich fee* 
afe charged mui . t a4*» be dei . ignated. 44*e locally 
dei . igriated incom e range fof fee* muot be within 
Ae perc e ntage levelf . e+" the otato'o e ' jtabh ' jhed ifi- 
come proLvcribed » f»4 ©f tbi* Rule. Authonty 
fof thec . e decii . iono ohall fe*t- with each county 
board ef social Der . 'iceo. 



SECTION .0200 - ELIGIBILITY 
DETERMIN.VnON 

.0204 MEIIIOD OF DETERMINING NEED 
FOR SERVICES 

i\x\ assessment of need shall be required for 
services provided on the basis of need without 
regard to income and funded under the Social 
Services Block Grant (Title XX). The determi- 
nation of need shall be made in accordance with 
procedures set forth m the Pamilv Services Ma- 
nual, as descnbcd in 10 NCAC 35A .0003. 



Slatutoiy Authority G.S. 1 43 B- 1 53. 

.0003 AMOLNT OF FEES 

WHiero (+» county board ef social senices de- 
tennines tbat- fee* wiH be charged fof certain fen* 
services, The amount of the fees charged for 
those services shall be in accordance with the fee 
schedules adopted by the Social Services Com- 
mission and published by the Division of Social 
Services. Copies of the fee schedules may be 
obtained from the Division of Social Services, 
325 North Salisbury' Street, Raleigh, North Ca- 
rolina, 27611. In addition, the fee schedules are 



952 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



available for public inspection during normal 
business hours in the division offices and in each 
county department of social services. 

Statutory Authority G.S. I43B-I53. 

.0004 ADJLSTVIENTS IN FEES 

(b) Adjustments for Service Provided to More 
Than One Family Member. When a fee service 
is provided to more than one member, of the 
same family, an adjustment in the amount of fee 
to be charged will be made as follows: 

(1) Chore Services, aft4 Homemaker Services 
and Personal and Family Counseling. 
Where chore scr\'ices, ef homemaker ser- 
vices or personal and family counseling is 
provided to more than one family mem- 
ber, the hourly fee for the service is di- 
vided equally among the family members 
receiving the service. 

Statutory Authority G.S. I43B-I53. 

.0005 \1A.\I\IL\1 FEE CH.ARGES 

te order fte* te diocourago Ae t»e »f noadod 
sop i ioQO. Except for transportation services and 
the resource items of housing and home im- 
provement services, the fee schedules adopted by 
the Social Services Commission provide for a 
maximum amount which may be charged a fa- 
mily in total fees during any one month. The 
schedule of maximum fees is adjusted according 
to family size and income. .Maximum fee sche- 
dules are available for inspection and may be 
obtained in accordance with Rule .0003 of this 
Section. 

Statutory Authority G.S. I43B-I53. 

.0006 MINIMUM FEE CH.VRGES 

Fee charges will be disregarded when the total 
amount due is less than 6v« doUars ($5.00) ten 
doUars ($10.00) per month. 

Statutory Authority G.S. I43B-I53. 

.0007 NON-PAYMENT OF FEES 

Reimbursement to the county department of 
social services or other provider will be termi- 
nated after a service has been provided for as long 
as thrc ' o two consecutive months without full 
payment of the fee due for provision of that ser- 
vice. 

Statutory Authority G.S. I43B-I53. 

.0009 FEES: WITHOUT REGARD TO INCOME 
TEST (REPEALED) 



Statutory Authority G.S. 143-153. 

CHAPTER 47 - STATE/COUNTY SPECIAL 
ASSISTANCE 

SUBCHAPTER 47B - ELIGIBILITY 
DETERMINATION 

SECTION .0400 - ELIGIBILITY FACTORS 

.0404 RESERVE 

(a) Eligibility Requirement. 
(1) To determine eligibility, the eligibility 
specialist shall count only resources that 
are currently available to the 
applicant/recipient. For applications, 
only those resources that are available 
during any month prior to disposition are 
counted to determine eligibility for those 
months. A resource shall be considered 
available not only when it is actually 
available but also when the 
applicant/recipient has a legal interest in 
a resource and can make it available. 

(A) Wlien a representative alleges that an 
applicant recipient is mentally incompe- 
tent and does not have a legal represen- 
tative appointed to act in his behalf, the 
resources held solely by the 
applicant recipient or held jointh' .shall be 
excluded in determining countable reserve 
provided the following two conditions are 
met: 

(i) the petition to have an 

applicant recipient declared incompe- 
tent is filed with the court within 30 
calendar days from the date the 
applicant's recipient's representative is 
informed of the requirement; and 

(ii) the petition to have a legal guardian 
appointed is filed with the court within 
30 calendar days of the date the 
applicant s recipient 's representative is 
informed of the requirement. 

(B) The county department of social ser- 
vices shall petition the court for incompe- 
tency and appointment of a guardian ifi 
(i) the applicant recipient has no repre- 
sentative willing to act in his behalf or 
the representative or guardian refuses to 
take the required action. Fhe county 
shall petition the court to have the 
applicant recipient declared incompe- 
tent and to ha\e a guardian appointed 
within 30 calendar days from the date 
it learns of the representative's refusal. 

(ii) the applicant's recipient's represen- 
tative fails to take the required action 
within 30 calendar days of the date he 



NORTH CAROLINA REGISTER 



953 



PROPOSED RULES 



was informed of the requirement. The 
county shall vsithin j_5 calendar davs 
from this date, petition the court to 
have the applicant recipient declared 
incompetent and to have a legal guard- 
ian appointed. 
If the conditions in Subparagraph (B)(i) 
and (ii) are met, the resources held solely 
by the applicant recipient or held jointly 
shall be excluded in determining counta- 
ble rcsene. 
fC) When the court rules that the 
applicant recipient is competent, his re- 
sources shall be c ounte d beginning the 
first day 



the month following the 



i^omment Procedures: AH interested persons 
are invited to attend. Comments may be submit- 
ted in writing or may be presented orally at the 
hearing. Oral presentations which exceed three 
minutes are requested to have a written copy to 
be filed with the hearing clerk at the hearing. 
Further details of the proposed repeals and 
adoptions may be obtained by writing or calling: 
Mr. Bill Flournoy, Div. of Planning and Assess- 
ment, P.O. Box 276S7, Raleigh. XC 27611 
Phone: (919) 733-6376. 



the CH.\PTER 1 - DEPARTMENTAL RULES 



month he is declared competent. 
[D) When the court declares 



the 



applicant recipient incompetent and ap- 
points a guardian, the guardian must take 
appropnate action to dispose of or make 
exempt the resource within 30 calendar 
days of his appointment. ]f he does not, 
the county department of social ser\ices 
shall determine if the guardian is acting 
appropnalelv under the terms of the 
guardianship, 
fl:) If the guardian takes the appropnate 
action to dispose of or make exempt the 
resource, the resource shall be excluded 
until the clerk of court confinris the action 
taken b\ the guardic 



I he res(Hirce shall 

be counted m rescr\e begmmng the first 
day of the month following the month the 
action is confirmed bv the clerk of court. 



Statutory A uihoritv 
143B-I53. 



G.S. I08A-4I; JOSA-46: 



TITLE 15 - DEPARTMENT OF NATT RAL 

RESOL RCES .\ND COMMLTsITV 

DEVELOPMENT 

1\ otice is hereby gi\'en in accordance with G.S. 
1 508- 1 2 that the .\.C. Department of Natural 
Resources and Community Development intends 
to repeal rule(s) cited as IS NCAC ID .0/0/ - 
.0/09; and adopt rule(s) cited as /5 XCAC /D 
.020/ - .0202. .0301 - .0304, .040/ - .0403. .050/ 
- .0504. .060/ - .0604. 

1 he proposed effective date of this action is Slav 
I. 1989. 

1 he public hearing will be conducted at 10:00 
a.m. on February /6. /9S9 at Ground Floor 
Hearing Room, Archdale Building, 5/2 N. Saiis- 
bwy Street, Raleigh, .V.C. 



SUBCHAPTER ID - CONFORMITY WITH 

NORTH CAROLINA EN\ IRONMENTAL 

POLICY ACT 

SECTION .0100 - GENERAL PROVISIONS 

.0101 PURPOSE (REPEALED) 
.0102 INCORPORATION OF ST.^TE 

REGULATIONS (REPEALED) 
.0103 RESPONSIBLE STATE OFFICIAL: 

DELEGATION (REPEALED) 
.0104 APPLICABILITY OF ACT TO 

DEPARTMENT ACTIONS (REPEALED) 
.0105 EFFECT OF PROPOSED ACTION ON 

THE EN\ IRONMENT OF THE ST,\TE 

(REPEALED) 
.0106 PREPARATION AND FORM OF 

EN\ IRONMENTAL IMPACT STATEMENT 

(REPEALED) 
.0107 REVIEW PROCEDURES FOR 

EN\ IRONMENTAL IMPACT STATEMENTS 

(REPEALED) 
.0108 APPROVAL AND PREPARATION OF 

EN\ IRONMENTAL IMPACT STATEMENT 

(REPEALED) 
.0109 RECORD OF ACTIONS (REPEALED) 

Statutory Authority G.S. I/3A, Article / ; 
/43B-/6. 

SECTION .0200 - GENERAL PROVISIONS 

.0201 ST.\TEMENT OF PURPOSE: POLICY: 
AND SCOPE 

(a) The purpose of the rules in this Subchapter 
is to establish procedures within the Department 
of Natural Resources and Community Develop- 
ment (NRCD) for conforming with the North 
Carolina Environmental Policy Act (NCEPA). 

(1) Rules for implementation of the NCEPA 
( 1 NCAC 25) are hereby incorporated by 
reference to include further amendments 
pursuant to G.S. 150B-14(cj. 

(2) The NRCD's procedures must insure that 
environmental documents are available to 
public otTicials and citizens before deci- 



954 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



sions arc made and before actions are 
taken. The information must by of high 
quality and sufficient to allow selection 
among alternatives. 

(b) The secretary is the "responsible state ofTi- 
cial" for NRCD. The secretary may delegate 
responsibility for the implementation of the 
NCEPA to appropriate staff. 

(c) The provisions of the rules in this Sub- 
chapter, the state rules (1 NCAC 25), and the 
NCEPA must be read together as a whole in or- 
der to comply with the spirit and letter of the law. 

(d) For the purpose of this Chapter: 

(1) "Agency" means the Divisions and Offices 
of NRCD, as well as the boards, com- 
missions, committees, and councils of 
NRCD with decision-making authority; 
except where the context clearly indicates 
otherwise. 

(2) "Cumulative Effect" results from the in- 
cremental impact of the proposed activity 
when added to other past, present, and 
reasonably foreseeable future activities re- 
gardless of what entities undertake such 
other activities. Cumulative effects can 
result from individually minor but collec- 
tively significant activities taking place 
over a period of time. 

(3) ".Major Activity" means any activity with 
a potential for significantly affecting the 
quality of the environment, depending 
upon how the activity is carried out, in- 
cluding but not limited to construction, 
management, and maintenance programs 
and projects. 

(4) "Non- Major Activity" includes those ac- 
tivities that are clearly not major and have 
only a minimum potential for significantly 
affecting the quality of the environment. 

(5) "Non-State lintity" includes local govern- 
ments, special purpose units of govern- 
ment, contractors, and 
individuals corporations to which the 
NCEPA may apply. 

(6) "Secondary Effects" are caused by and re- 
sult from the proposed activity although 
they are later in time or farther removed 
in distance, but they are still reasonably 
foreseeable. 

(7) "Secretary" means the Secretary of 
NRCD. 

Statutofy Authoritv G.S. II3A, Article I; 
MSB- JO. 

.0202 .\GENCY COMPLIANCE 
Each NRCD agency shall interpret the pro- 
visions of the NCEPA as a supplement to its 



existing authority and as a mandate to view its 
policies and programs in the light of the 
NCEPA's comprehensive environmental objec- 
tives, except where existing law apphcable to the 
agency's operations expressly prohibit or make 
comphance impossible. 

Statutory Authoritv G.S. I13A, Article I; 
1 43 B- 10. 

SECTION .0300 - INTEGRATION WITH 
AGENCY ACTIVITY 

.0301 EARLY APPLICATION OF THE NCEPA 

(a) Environmental documents shall be prepared 
for the following agency activities, where it is 
deemed by the secretary that a potential effect 
upon the environment of the state may result. 
This does not include activities excluded by the 
minimum criteria set out in Section .0600 of this 
Subchapter. 

(1) Proposed master plans and management 
plans for the development or management 
of lands and waters owned or managed 
by any NRCD agency, including pubUc 
trust areas. 

(2) Proposed construction of facilities or in- 
frastructures on lands and waters owned 
or managed by any NRCD agency. This 
requirement may be met in-whole or in- 
part through the fulfillment of Subpara- 
graph (a)(r) of this Rule. 

(3) Specific programs conducted by NRCD 
agencies on lands and waters or in the at- 
mosphere owned or managed by the state. 

(4) Projects to be conducted by governmental 
agencies or for projects to be supported 
in-whole or in-part by public monies, and 
requiring NRCD approval. 

(b) Environmental documents shall be issued 
by NRCD agencies for local government and 
private activities in those cases where NRCD has 
State Project Agency responsibihty. 

Statutory Authoritv G.S. II3A, Article I; 
J43B-/0. 

.0302 WHEN TO PREPARE ENVIRONMENTAL 
DOCUMENTS 

(a) Agencies may prepare an environmental 
evaluation, and use the NCEPA process for 
structure, on any activity at any time in order to 
assist agency planning and decision-making. 

(b) Agencies shall prepare an environmental 
assessment in accordance with the NCEPA and 
the related state rules at 1 NCAC 25 for those 
activities above the thresholds set in NRCD's 
minimum criteria as set out in Section .0600 of 
tliis Subchapter. 



NOR TH CA R OL IN A REGIS TER 



955 



PROPOSED RULES 



(c) An assessment is not neccssan,' if an agency 
has decided to prepare an environmental impact 
statement, because the scope or complexity of 
the activity has a clear potential for environ- 
mental effects. 



Staiutory 
143B-I0. 



Aulhoritv G.S. II3A, Article 1; 



.O.M)3 IKAH AND COOPKRATING AGENCY 
RKSPONSIBIMTV 

Where NRCD is the State Project Agency the 
seeretar\' shall appoint a lead agency and coop- 
erating agencies as appropriate. The lead and 
cooperating agency's responsibiUties shall be es- 
tablished bv the secretarA'. 



Stdiuton Authoriiv 
!43n-/6. 



G.S. I ISA. Article J: 



.0304 SCOPING AND IIKARINGS 

NRCD agencies shall utilize scoping and hear- 
ing processes in their NCI: PA acti\ities appro- 
priate to the complexity, potential for 
en\ironmental effects, imd level of expressed in- 
terest associated with the proposed activity. 
Scoping and hearings shall be carried out in a 
manner estabhshed bv the secretar\ . 



Stiitutor\- 
1438-10. 



tuthoriiv G.S. 113.1. Article I; 



SKCTION .0400 - PRKPARATION OF 
KNMRONMENIAl. DOCUMENTS 

.0401 IMPLEMENTAIION 
NRCD agencies shall prepare environmental 
documents in accordance with the NCEPA, its 
related rules at 1 NCAC 25, the rules in this 
Subchapter, and procedures established by the 
secretar>'. 

Statuton Authoriiv G.S. 113.4. Article I; 
1438-10. 

.0402 INCORPORATION BV REFERENCE 

(a) Agencies shall incorporate material into 
environmental documents by reference to cut 
doun on bulk without impeding agency and 
public re\iews of the action. The incorporated 
matenal shall be cited in the document and its 
contents brietly descnbcd. 

(b) Incorporated-by-reference matenal must be 
reasonably available for inspection by reviewers 
and potentially interested persons within the time 
allowed for comment. 



.0403 INCOMPLETE OR LNA\ AILABLE 
INFORMATION 

(a) Where an agency is evaluating significant 
effects upon the environment in an environ- 
mental document and there are gaps in rele\ant 
information or scientific uncertainty, the agencv 
should always make clear that such information 
IS lacking or that uncertainty exists. 

(b) If the information relevant to the effects is 
essential to a reasonable choice among alterna- 
tives and the overall costs of and time for ob- 
taining it are not out of proportion to the 
potential env'ironmental effects of the activity, the 
agency should include the information in the en- 
vironmental document. 

(c) If the information relevant to the effects is 
essential to a reasoned choice among alternatives 
and the overall cost of and time for obtaining it 
are out of proportion to the potential environ- 
mental effects of the activity, or the means of 
obtaining it are not known (beyond the state of 
the art), then the agency shall weigh the need for 
the action against the risk and severity of possible 
adverse impacts were the action to proceed in the 
face of uncertainty. If the agency proceeds, it 
shaU include witliin the environmental docu- 
ment: 

( 1 ) a statement that such information is in- 
complete or una\ailable; 

(2) a statement of the rele\'ance of the in- 
complete or unavailable information to 
evaluating reasonably foreseeable signif- 
icant adverse impacts on the human envi- 
ronment; 

(3j a summan.' of existing credible scientific 
evidence which is relevant to evaluating 
the reasonably foreseeable significant ad- 
verse impacts on the human environment; 
and 

(4) the agency's evaluation of such impacts 
based upon theoretical approaches or re- 
search methods generally accepted in the 
scientific community. For the purposes 
of this Section, "reasonably foreseeable" 
includes impacts which have catastrophic 
consequences, even if their probability of 
occurrence is low, pro\ided that the anal- 
ysis of the impacts is supported by credi- 
ble scientific evidence, is not based on 
pure conjecture, and is within the rule of 
reason. 



Statuton' .-iuthoritv 
1438-10. 



G.S. 113A. .Article 1 ; 



Statuton' 
1438-10. 



Authority G.S. 113.4, Article 1; 



SECTION .0500 - OTHER REQUIREMENTS 



956 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



.0501 AGENCY DECISION-MAKING 
PROCEDURES 

To ensure that NRCD agency decisions are 
made in accordance with the policies and pur- 
poses of the NCEPA, the continuing responsi- 
bility for conforming existing and new procedures 
and rules shall be conducted in accordance with 
the directives of the secretary. 

Statutory Authorilv G.S. I ISA, Article I; 
143B-I0. 

.0502 LIMITATION ON ACTIONS DURING 
NCEPA PROCESS 

(a) \\1iile work on an environmental document 
is in progress and the activity is not covered by 
an existing environmental document, no agency 
shall undertake Ln the interim any action which 
might; 

(1) limit the choice among alternatives or 
otherwise prejudice the ultimate decision 
on the issue; or 

(2) have an environmental effect of its own. 

(b) If an agency is considering a proposed ac- 
tion for which an environmental document is to 
be or is being prepared, the agency shall 
promptly notify the initiating party that the 
agency cannot take final action untU the envi- 
ronmental documentation is completed and 
available for use as a decision-making tool. The 
notification shall be consistent with the statutory 
and regulatory requirements of the agency and 
may be in the form of a notification that the ap- 
plication is incomplete. 

(c) When an agency decides that a proposed 
activity, for which state actions are pending or 
have been taken, requires environmental doc- 
umentation then the agency should promptly 
notify all action agencies of the decision. When 
statutory and regulatory requirements prevent an 
agency from suspending action, the agency shaU 
deny any action for which it determines an envi- 
ronmental document is necessary but not yet 
available as a decision-making tool. 

Statutory Authority G.S. II3A, Article I; 
MSB- 10. 

.0503 EMERGENCIES 

(a) Where emergency circumstances make it 
necessary to take an othenvise lawful action with 
potential environmental effects without observing 
the public review provisions of the NCBPA, the 
agency taking the action should notify the secre- 
tary and limit actions to those necessary to con- 
trol and mitigate for the immediate threat to the 
pubbc health, safety, and welfare. 



(b) Agencies are encouraged to prepare and 
maintain en\ ironmcntal documents for repetitive 
emergency programs affecting the public, to re- 
view the scope of involved activities, identify 
specific effects to be expected, and mitigation 
measures that can be employed in various cir- 
cumstances to assure protection of the public and 
long-term environmental productivity. 

Statutory Authority G.S. USA, Article I; 
MSB- 10. 

.0504 NON-STATE INVOLVEMENT AND 
CONTRACTORS 

(a) If a lead agency requires a non-state entity 
to submit environmental information for use by 
the agency in preparing an environmental docu- 
ment for the non-state entity's activity, then the 
agency shall assist by outlining the types of in- 
formation requested. The agency shall inde- 
pendently evaluate the information provided and 
shaU be responsible for its accuracy. 

(b) If a lead agency permits a non-state entity 
to prepare an environmental document, the lead 
agency shall furnish guidance and participate in 
the preparation, and take responsibility for its 
scope, objectivity, content, and accuracy. 

(c) An environmental document may be pre- 
pared by a contractor, either selected by or ac- 
ceptable to the lead agency. 



Statutory Authority G.S. 
MSB- 10. 



USA, Article I: 



SECTION .0600 - MINIMUM CRITERIA 

.0601 PURPOSE 

This Section establishes minimum criteria to be 
used in determining when environmental docu- 
ments are not required. The minimum criteria, 
as defmed in state rules at 1 NCAC 25, shall be 
used by the secretary and NRCD agencies to 
provide sound decision-making processes by al- 
lowing separation of activities with a high po- 
tential for environmental effects (major) from 
those with only a minimum potential (non-ma- 
jor). 



Statutory Authority 
MSB- 10. 



G.S. USA, Article I; 



.0602 M.VIOR ACTIVI LIES 

(a) Major activities requiring environmental 
documents for review by decision-makers and the 
public are those presented in Section .0300 of this 
Subchapter, and not otherwise excluded by these 
minimum criteria. 

(b) Major activities taken after preparation of 
and in conformance with a master plan, man- 



NORTH CAROLINA REGISTER 



957 



PROPOSED RULES 



agement plan, or program for which an environ- 
mental document was completed, may require an 
environmental assessment, a fmding of no signif- 
icant impact, or a record of decision. Determi- 
nation of which type of document is most 
appropriate will be made after considering: 

(1) the need for updating information in the 
earher broader document as it relates to 
current conditions and the proposed ac- 
tivity, and 

(2) the specificity and sufficiency of the earlier, 
broader document in addressing the effects 
of the proposed activity. 

(c) Demolition of or additions, rehabilitation 
and/or renovations to a structure hstcd in the 
National Register of Historic Places or more than 
50 years of age except where agreement exists 
with the Department of Cultural Resources that 
the structure lacks architectural or historical sig- 
nificance. 

(d) Ground disturbances involving Natural 
Register listed archaeological sites or areas 
around buildings 50 years old or older, except 
where agreement exists with the Department of 
Cultural Resources. 



Statutoty Aiithoritv G.S. 
1438-10. 



I ISA, Ankle I; 



.0603 EXCEPTIONS lO MIMMIM CRITERIA 

Any activity falling within the parameters of the 
minimum criteria set out ia Rule .0604 of this 
Section will not routinely be required to have 
environmental documentation under the 
NCEPA. However, the Secretary of NRCD may 
determine that environmental documents under 
the NCEPA are required in any case where one 
of the following fmdings appUes to a proposed 
activhy. 

(1) The proposed activity may ha\-e a potential 
for significant adverse effects on wetlands, 
parklands, prime or unique agricultural 
lands, or areas of recognized scenic, recre- 
ational, archaeological, or historical value 
including indirect etfects; or would threaten 
a habitat identified on the Department of 
Interior's or state's threatened and endan- 
gered species lists. 

(2) The proposed activity could cause signif- 
icant changes in industrial, commercial, res- 
idential, agricultural, or sil\icultural land use 
concentrations or distributions which would 
be expected to create ad\erse water quaHty, 
air quality, or ground water impacts; or af- 
fect long-term recreational benefits, sheUfish, 
wildlife, or their natural habitats. 

(3) The proposed activity has secondar,' im- 
pacts, or is part of cumulative effects, not 



generally covered in the approval process for 
the state action, and that may result in a 
potential risk to human health or the envi- 
ronment. 
(4) The proposed activity is of such an unusual 
nature or has such widespread implications 
that an uncommon concern for its environ- 
mental effects has been expressed to the 
agency. 

Statutory Authority G.S. I ISA, Article 1; 
I4SB-I6. 

.0604 NON-MAJOR ACTIVITY 

The following minimum criteria are estabhshed 
as an indicator of the types and classes of thres- 
holds of activity at and below which environ- 
mental documentation under the NCEPA is not 
required. As set out in Rule .0603 of this Sec- 
tion, the secretary may require envLronmental 
documentation for activities that would other- 
wise qualify under these minimum criteria thres- 
holds. 

(1) Sampling, survey, monitoring and related 
research activities including but not limited 
to the following: 

(a) Aerial photography projects in\ol\ing the 
photograpliing or mapping of the lands 
of the state. 

(b) Biological sampling and monitoring of 
fisheries resources through the use of tra- 
ditional commercial fishing gear, electric- 
ity, and rotenone. 

(c) Soil suney projects Lnvohing the sampling 
or mapping of the soils of the state. 

(d) Establishing stream gaging stations for the 
purpose of measuring water flow at a 
particular site. 

(e) Placement of monitoring wells for the 
purpose of measuring groundwater levels, 
quantity, or quality. 

(f) Gathering surface or subsurface informa- 
tion on the geology, minerals, or energy 
resources, of the state. 

(g) Placement and use of geodetic sur\'ey 
control points. 

(h) Other routine survey and resource moni- 
toring activities, or other temporary activ- 
ities required for research into the 
environment which have minimum long- 
term effects. 

(i) Activities that are proposed for funding 
under the North Carolina Community 
Development Block Grant Program that 
are exempt or categorically excluded from 
NEPA under the provisions of the Envi- 
ronmental Review Procedures at 24 CER 
Part 58. 



958 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(2) Standard maintenance or repair activities 
as needed to maintain the originally defined 
function of a project or facility (but without 
expansion, increase in quantity, or decrease 
in quality) including but not limited to the 
following: 

(a) Routine repairs and housekeeping projects 
which maintain a facility's original condi- 
tion and physical features, including re- 
roofmg and minor alterations where 
in-kind materials and techniques are used. 
This also encompasses structures 50 years 
of age and older and for which no separate 
law, rule, or regulation dictates a formal 
review and approval process. 

(b) Roads, bridges, parking lots, and their re- 
lated facilities. 

(c) Utilities (water, sewer, and electricity) on 
their existing rights-of-way. 

(d) Storm sewer and surface drainage systems. 

(e) Boat ramps, docks, piers, bulkheads, and 
associated facilities at water-based recre- 
ation sites. 

(f) Diked, highground dredge-material dis- 
posal areas. 

(g) Activities necessary to fulfill the existing 
requirements of in-effect permits for the 
protection of the environment and human 
health. 

(h) Other maintenance and repair activities 
on previously approved projects, consist- 
ent with existing environmental docu- 
ments. 

(i) Activities that are proposed for funding 
under the North Carolina Community 
Development Block Grant Program that 
are exempt or categorically excluded from 
NEPA review under the provisions of the 
Environmental Review Procedures at 24 
CFR Part 58. 

(3) Minor construction activities including but 
not limited to the following: 

(a) New and expanded surface discharge fa- 
cilities less than 1,000,000 gallons per day 
and not resulting in the loss of any exist- 
ing use. 

(b) Waste water spray irrigation and rotary 
distributor systems not greater than 
100,000 gallons per day. 

(c) Sludge disposal facilities on sites of less 
than 300 cumulative acres and for which 
the sludge has been determined to be not 
a hazardous waste. 

(d) Sewer extensions with less than five miles 
of new lines and a design volume not ex- 
ceeding 2,000,000 gallons per day, or in- 
dividual pump stations not exceeding 
2,000,000 gaUons per day. 



(e) New and expanded subsurface waste water 
systems with a final design capacity not 
exceeding 100,000 gallons per day. 

(f) Groundwater withdrawals of less than 
1,000,000 gallons per day where such 
withdrawals are not expected to cause a 
significant alteration in established land 
use patterns, or degradation of groundwa- 
ter or surface water quality. 

(g) Air emissions of pollutants from a minor 
source or modification as defmed in 15 
NCAC 2D .0530, that are less than 100 
tons per year or 250 tons per year as de- 
fmed therein. 

(h) Dams less than 25 feet in height and hav- 
ing less than 50 acre feet of storage ca- 
pacity. 

(i) Routine grounds maintenance and land- 
scaping, such as sidewalks, trails, walls, 
gates, and related facilities, including out- 
door exhibits. 

(j) Any new building construction involving 
the following: 
(i) less than 10,000 square feet; 
(ii) less than twenty five thousand dollars 

($25,000.00) cost; 
(iii) less than one acre of previously undis- 
turbed ground, unless the site is a Na- 
tional Register archaeological site; or 
(iv) no handling or storage of hazardous 
materials in the completed facility. 

(k) Demolition of or additions, rehabilitation 
and/or renovations to a structure not 
listed in the National Register of Historic 
Places or less than 50 years of age. 

(1) Activities that are proposed for funding 
under the North Carolina Community 
Development Block Grant Program that 
are exempt or categorically excluded from 
NEPA review under the provisions of the 
Environmental Review Procedures at 24 
CFR Part 58. 
(4) Management activities including but not 
limited to the following: 

(a) Replenishment of shellfish beds through 
the placement of shell or seed oysters on 
depicted and/or suitable marine habitat. 

(b) Creation and enhancement of marine 
fisheries habitat through the establishment 
of artificial reefs on Environmental Pro- 
tection Agency, U.S. Army Corps of En- 
gineers, National Marine Fisheries 
Service, and U.S. Fish and Wildlife Ser- 
vice approved sites, including the use of 
artificial reef construction material requir- 
ing an EPA certificate of cleanliness from 
petroleum based products and other pol- 
lutants. 



NORTH CAROLINA REGISTER 



959 



PROPOSED RULES 



(c) Placement of fish attractors and shelter in 
pubhc waters. 

(d) Translocation and stocking of native fish 
and wildlife in accordance with wildlife 
management plans. 

(e) Reintroduction of native endangered or 
threatened species in accordance with 
I-"ederal guidelines or reco\er>' plans. 

(f) Production of nati\c and agricultural plant 
species to create or enhance fish or wildlife 
habitat and forest resources, including 
fertilization, planting, mowing, and burn- 
ing in accordance with management plans. 

(g) Timber harvest in accordance with the 
National Poorest Ser\'ice or the N.C. Divi- 
sion of Forest Resources timber manage- 
ment plans. 

(h) Reforestation of timberlands in accord- 
ance with the National Forest Service or 
the N.C. Di\ision of Forest Resources 
timber management plans. 

(i) Control of forest or agricultural insects and 
disease outbreaks, by the lawful applica- 
tion of labeled pesticides and herbicides 
by Ucenscd applicators, on areas of no 
more than 100 acres. 

(j) Control of aquatic weeds in stream chan- 
nels, canals, and other water bodies, by 
the lawful application of labeled herbi- 
cides by licensed applicators, on areas of 
no more than two acres or 25 percent of 
the surface area, whiche\'cr is less. 

(k) Removal of logs, stumps, trees, and other 
debris from stream channels where there 
is no channel excavation, and activities are 
carried out in accordance with Stream 
Obstruction Removal Guidelines pre- 
pared by the Stream Renovation Guide- 
lines Committee of the Wildlife Society 
and the American Fisheries Society. 

(1) Dredging of existing navigation channels 
and basins, provided that the spoil is 
placed in existing and approved high 
ground disposal areas. 

(m) Controlled or prescribed burning for 
wUdUfe and timber enhancement in ac- 
cordance with applicable management 
plans. 

(n) Discharges of water treatment plant filter 
backwash and swimming pool filter back- 
wash. 

(o) Drainage projects where the mean sea- 
sonal water table elevation wiU not be 
lowered more than one foot over an area 
of five square miles or less. 

(p) Manipulation of water levels in reservoirs 
or impoundments in accordance with ap- 
proved management plans, for the pur- 



pose of providing for water supply 
storage, flood control, recreation, hydro- 
electric power, and fish and wildlife. 

(q) Increases or modification in previously 
permitted discharges not exceeding 
1,000,000 gallons per day. 

(r) Installation of on-faim Best Management 
Practices for the N.C. Cost Share Pro- 
gram For Nonpoint Source PoUution 
Control codified as 15 NCAC 6E. 

(s) Continuation of previously permitted ac- 
tivities where no increase in quantity or 
decrease in quality are proposed. 

(t) Acquisition or acceptance of real property 
to be retained in a totally natural condi- 
tion for its environmental benefits, or to 
be managed in accordance with plans for 
which environmental documents have 
been approved. 

(u) Care of all trees, plants, and groundcovers 
on public lands. 

(v) Care, including medical treatment, of all 
animals maintained for public display. 

(w) Activities that are proposed for funding 
under the North Carolina Community 
Development Block Grant Program that 
are exempt or categorically excluded from 
NEPA review under the provisions of the 
En\'ironmcntal Re\iew Procedures at 24 
CFR Part 58. 

Statutoty Authority G.S. II3A, Article I; 
MSB- 10. 



J\ otice is hereby gi\'en in accordance with G.S. 
I SOB- 1 2 that the N.C. Department of Natural 
Resources and Community DeX'elopment (DEM J 
intends to amend rule(s) cited as 15 NCAC 2B 
.0305. 



Th 



he proposed effecti\-e date of this action is July 
I. 19S9. 

1 he public hearing will be conducted at 7:00 
p.m. on February 15, I9S9 at Cafeteria, Valle 
Crucis Elementary School, Route I , Sugar Grove, 
NC 28679. 

C ommcnl Procedures: A II persons interested in 
this matter are invited to attend. Comments, 
statements, data and other information may be 
submitted in writing prior to, during, or within 
thirty (30) days after the hearing or may be pre- 
sented orally at the hearing. Oral statements may 



960 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



be limited at the discretion of the hearing officer. 
Submittal of written copies of oral statements is 
encouraged. 

CHAPTER 2 - ENVIRONMENTAL 
MANAGEMENT 

SUBCHAPTER 2B - SLRFACE WATER 
STANDARDS: MONITORING 

SECTION .0300 - ASSIGNMENT OF STREAM 
CLASSIFICATIONS 

.0305 WATALGA RIVER BASIN 

(c) The Watauga River Basin Schedule of 
Classifications and Water Quality Standards was 
amended effective: 

(1) August 12, 1979; 

(2) February' 1, 1986; 

(3) October 1, 1987; 

(4) July 1. 1989. 

(d) The Schedule of Classifications and Water 
Quality Standards for the Watauga River Basin 
was amended etTective July J_, 1989 as follows: 

(1) Dutch Creek (Index No. 8-11) was reclas- 
sified from Class C-trout to Class B-trout. 

(22 Pond Creek (Index No. 8-20-2) from wa- 
ter supph' intake (located just above I'a- 
marack Road) to ik-cch Oeck and all 
tributary' waters were reclassified from 
Class WS-lII to C. 



Statutory Authority G.S. 143-214.1: 
l43-2l5.3(a)(l). 



143-215.1; 



ly otice is hereby given in accordance with G.S. 
I SOB- 12 that the i\.C. Department of Natural 
Resources and Community Development (DEM) 
intends to amend rule(s) cited as 15 NCAC 2B 
.0307. 

1 he proposed effective date of this action is July 
1, 1989. 

1 he public hearing will be conducted at 7:00 
p.m. on February 16, 1989 at Courtroom, Ashe 
County Courthouse, Jefferson, NC 28640. 

\^ omment Procedures: All persons interested in 
this matter are invited to attend. Comments, 
statements, data and other information may be 
submitted in writing prior to, during, or within 
thirty (30) days after the hearing or may be pre- 
sented orally at the hearing. Oral statements may 
be limited at the discretion of the hearing officer. 



Submittal of written copies of oral statements is 
encouraged. 

.0307 NEW RIVER BASIN 

(c) The New River Basin Schedule of Classi- 
fications and Water Quality Standards was 
amended effective: 

(1) August 10, 1980; 

(2) April 1, 1983; 

(3) February 1, 1986; 

(4) July 1. 1989. 

(d) The Schedule of Classifications and Water 
Quality Standards for the New River Basin was 
amended effective July J_^ 1989 as follows: 

(1) South Fork New River [Index No. 
10-1-(30)1 from Dog Creek to New River 
and all tributary waters were reclassified 
from Class Otrout and Class C to Class 
B-trout and B. 

Statutory Authority G.S. 143-214.1; 143-215.1; 
143-215.3(a)(l). 



ly Otice is hereby gr\'en in accordance with G.S. 
1 SOB- 1 2 that the North Carolina Wildlife Re- 
sources Commission intends to amend rule(s) 
cited as 15 NCAC lOB .0203; IOC .0208; and 
lOD .0003. 

1 he proposed effective date of this action is July 
1, 1989. 

1 he public hearing will be conducted at 10:00 
a.m. on Febmary 15, 1989 at Room 386, Archdale 
Bldg, 512 N. Salisbury Street, Raleigh, N.C. 

v_- omment Procedures: Interested persons may 
present their views either orally or in writing at the 
hearing. In addition, the record of hearing will 
be open for receipt of written comments from 
January 31, 1989 to March 2, 1989. Such written 
comments must be delivered or mailed to the 
Wildlife Commission, 512 N. Salisbury St., Ra- 
leigh, NC 2761 1 . 

CHAPTER 10 - WILDLIFE RESOURCES AND 
WATER SAFETY 

SUBCHAPTER I OB - HUNTING AND 
TR.VPPING 

SECTION .0200 - HUNTING 

.0203 DEER (WHITE-TAILED) 

(b) Open Seasons (/Ml Lawful Weapons) 



NORTH CAROLINA REGISTER 



961 



PROPOSED RULES 



(1) Male Deer With Visible Antlers. Male 
deer with antlers or spikes protruding 
through the skin, as distinguished from 
knobs or buttons covered by skin or vel- 
vet, may be taken during the following 
seasons: 
(A) Monday on or nearest October 15 to 
January 1 in the following counties and 
parts of counties: 



Beaufort 

Bertie 

Bladen 

Brunswick 

Camden 

Carteret 

Chowan 

Columbus* 

Craven 

Currituck 

Dare 

l,enoir 

Martin 

Nash 

New Hanover 

Northampton 

Onslow 

Pamlico 

Pasquotank 

Pender 

Perquimans 



Duplin 

Edgecombe 

Franklin 

Gates 

Greene 

Halifax 

Hertford 

Hoke 

Hyde 

Jones 

Pitt 

Richmond** 

Robeson 

Scotland** 

Tyrrell 

Vance 

Warren 

Washington 

Wa\'ne 

WUson 



'i'lnku' i ful to hunt 9* kiii deef i» lako 
Waccama' . ' . ' et V i ithin 50 yardn »f it* 
f . hor e lin e . 

±±^;^ 44 NCAC W& .0003(d)(2) fef »^a- 
seft* e» Sandhills Gam e Land. 

Cumberland: All of the county except 

that part north of NC 24 east of Fay- 

etteviUe and east of NC 210 north of 

Fayetteville. 
Harnett: That part west of NC 87. 
Johnston: All of the county except that 

part south of US 70 and west of 1-95. 
Moore^: That part south of NC 21 1 and 

east of US 1. axcopt &» t^ Sandhillr 

Gdfft# t-«*4 H*^ +4 NCAC +0© 

.0003(dj(2)|. 
Sampson: /Vll of the county except that 

part west of NC 242 and north of US 

13. 
Wake: That part north of NC 54 west of 

Raleigh and US 70 east of Raleigh. 

* Unlawful to hunt or kill deer in Fake 
Waccamaw or within 50 vards of its 
shoreline. 



**See 15 NCAC lOD ■0003(d)(2) for sea- 
sons on Sandhills Game Land. 

Statutory Authority G.S. 113-134; 113-270.3; 
1 1 3-276.1: II 3-29 1. 1; 1 13-291.2. 

SLBCH.\PTER IOC - INLAND FISHING 
REGLL.ATIONS 

SECTION .0200 - GENER.\L REGLLATIONS 

.0208 SPA\\N.ING AREAS 

The following waters are designated as spawning 
areas in which fishing is prohibited or restricted 
as indicated: 

(1) No person shall fish by any method or at 
any time in, or within 50 feet of, the fish 
ladder at Quaker Neck Dam on Neuse River 
in Wayne County. 

(2) No person shall fish by any method from 
February 15 to April 15, both inclusive, in 
LinviUe River from the NC 126 bridge 
downstream to the backwater of Lake James 
in Burke County. 

(3) No person shall fish by netting in that 
portion of the Dan River lying within the 
State downstream from the Brantly Steam 
Plant at Danville, or in the Roanoke River 
between the L"S 258 bridge and the dam of 
Roanoke Rapids I>ake, or while in or on 
said rivers within said areas, have in pos- 
session any bow net, dip net or any landing 
net having a handle exceeding eight feet in 
length or a hoop or frame to which the net 
is attached exceeding 60 inches along its 
outside perimeter. 

{4} N*+ porrjon r . hall ft4i- hf aftv method k* 6«e 
TroL> Canal m I yrroU County within •§© 
yards ©f tiw I ak e Phelpo fr4* ladder. 

Statutory Authority G.S. 113-134; 113-292. 

SUBCH.\PTER lOD - GAME LANDS 
REGLL.\TIONS 

.0003 HUNTING ON GAME LANDS 

(c) Time and Manner of Taking. Except where 
closed to hunting or limited to specific dates by 
these regulations, hunting on game lands is per- 
mitted during the open season for the game or 
furbearing species being hunted. On managed 
waterfowl impoundments, hunters shall not enter 
the posted impoundment areas earlier than 4:00 
a.m. on the permitted hunting dates, and hunting 
is prohibited after 1:00 p.m. on such hunting 
dates; decoys may not be set out prior to 4:00 
a.m. and must be removed by 3:00 p.m. each 
day. On Butner-Falls of Neuse, New Hope and 
Shearon Harris Game Lands waterfowl hunting 



962 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



is prohibited after limilod te Ae poriod from 
ono half hour buforu Dunri'i e to 1:00 p.m. on the 
open hunting days. No person shall operate any 
vessel or vehicle powered by an internal com- 
bustion engine on a managed waterfowl im- 
poundment. 

No person shall attempt to obscure the sex or 
age of any bird or animal taken by severing the 
head or any other part thereof, or possess any 
bird or animal which has been so mutilated. 

No person shall place, or cause to be placed on 
any game land, salt, grain, fruit, or other foods 
without prior written authorization of the com- 
mission or its agent and no person shall take or 
attempt to take any game birds or game animals 
attracted to such foods. No person shall use an 
electronic calling device for the purpose of at- 
tracting wild birds or wild animals. 

No live wild animals or wild birds shall be re- 
moved from any game land, 
(d) Hunting Dates 
(2) Any game may be taken during the open 
seasons on the following game lands and 
hunting is limited to Mondays, Wednes- 
days, Saturdays and Thanksgiving, 
Christmas and New Years Days. In ad- 
dition, deer may be taken with bow and 
arrow on the opening day of the bow and 
arrow season for deer. Raccoon and 
opossum hunting may continue until 7:00 
a.m. on Tuesdays, until 7:00 a.m. on 
Thursdays, and until midnight on Satur- 
days. Additional restrictions apply as in- 
dicated in parentheses following specific 
designations: 
Ashe County— Carson Woods Game land 
Beaufort and Craven Counties— Big Pocosin 
Game l^and (Dogs may not be trained or 
used in hunting from March 2 to August 
31. Deer of either sex may be taken on 
November 30 and on December 3. 
Trapping is controUed by the landowner.) 
Bertie County--Bertie County Game lands 
Bladen County— Bladen Lakes State Forest 
Game I^nds (Handguns may not be 
carried and, except for muzzle-loaders, ri- 
fles larger than .22 caliber rimfu-e may not 
be used or possessed. On the Breece 
Tract and the Singletary Tract deer and 
bear may be taken only by .still hunting.) 
Cabarrus County — Riv e r View Acres Gam e 

Caswell County--Caswell Game Land 
(That part designated and posted as a 
"safety zone" is closed to aU hunting and 
trapping, and entry upon such area for 
any purpose, except by authorized per- 
sonnel in the performance of their duties, 



is prohibited. On areas posted as "re- 
stricted zones" hunting is limited to bow 
and arrow.) 

Catawba and IrcdeU Counties--Catawba 
Game Land 

Lenoir County— H.M. Bizzell, Sr., Game 
Land 

Onslow County— WTiite Oak River Im- 
poundment Game Land (In addition to 
the dates above indicated, waterfowl may 
be taken on the opening and closing days 
of the applicable waterfowl seasons.) 

Pender County— Holly Shelter Game Land 
(In addition to the dates above indicated, 
waterfowl may be taken on the opening 
and closing days of the applicable water- 
fowl seasons.) 

Richmond, Scotland and Moore Counties- 
-Sandhills Game Land (The regular gun 
season for deer consists of the open hunt- 
ing dates from the second Monday before 
Thanksgiving to the third Saturday after 
Thanksgiving except on the field trial 
grounds where the gun season is from the 
second Monday before Thanksgiving to 
the Saturday following Thanksgiving. 
Deer may be taken with bow and arrow 
on all open hunting dates during the bow 
and arrow season, as well as during the 
regular gun season. Deer may be taken 
with muzzle-loading firearms on Monday, 
Wednesday and Saturday of the second 
week before Thanksgiving week, and 
during the regular gun season. Except for 
the deer seasons above indicated and the 
managed either-sex permit hunts, the field 
trial grounds are closed to all hunting 
during the period October 22 to March 
31. In addition to the regular hunting 
days, waterfowl may be taken on the 
opening and closing days of the applicable 
waterfowl seasons.) 

Robef . on County — Keith Farm Gamo Land 
fNe deep may fe» taken.) 

Stokes County— Sauratown Plantation 
Game Land 

Yadkin County--IIuntsville Community 
Farms Game Land 
(3) Any game may be taken on the following 
game lands during the open season, except 
that: 

(A) Bears may not be taken on lands des- 
ignated and posted as bear sanctuaries; 

(B) Wild boar may not be taken with the 
use of dogs on such bear sanctuaries, and 
wild boar may be hunted only during the 
bow and arrow seasons and the regular 
gun season on male deer on bear sanctu- 



NORTH CAROLINA REGISTER 



963 



PROPOSED RULES 



aries located in and west of the counties 
of Madison, Buncombe, Henderson and 
Polk; 

(C) On game lands located in or west of the 
counties of Rockingham, Guilford, Ran- 
dolph, Montgomery and Anson, dogs 
may not be used for any hunting (day or 
night) during the regular season for hunt- 
ing deer with guns; except that small game 
may be hunted with dogs in season on alJ 
game lands, other than bear sanctuaries, 
in the counties of Cherokee, Clay, Jack- 
son, Macon, Madison, Polk and Swain; 

(D) On Croatan, Goose Creek, New Hope 
and Shearon Harris Game I^ands water- 
fowl may be taken only on Mondays, 
Wednesdays, Saturdays; on Thanksgiving, 
Christmas and New Years Days; and on 
the opening and closing days of the ap- 
phcable waterfowl seasons; except that 
outside the posted waterfowl impound- 
ments on Goose Creek Game Land 
hunting any waterfowl in season is per- 
mitted any week day during the last 10 
days of the regular duck season as estab- 
lished by the U.S. Fish and Wildlife Ser- 
vice: 

(E) On the posted waterfowl impound- 
ments of Gull Rock Game Land hunting 
of any species of wildlife is limited to 
Mondays, Wednesdays, Saturdays; 
Thanksgiving, Christmas, and New Years 
Days; and the opening and closing days 
of the applicable waterfowl seasons; 

(F) On bear sanctuaries in and west of 
Madison, Buncombe, Henderson and 
Polk Counties dogs may not be trained 
or allowed to run unleashed between 
March 1 and October 1 1 ; 

(G) On Butner- Falls of Neuse and Person 
Game Lands waterfowl may be taken only 
on Tuesdays, Thursdays and Saturdays, 
Christmas and New Year's Days, and on 
the opening and closing days of the ap- 
pHcable waterfowl seasons; 

(H) On Angola Bay, Croatan, Goose 
Creek, Hofmann Forest and Tuscarora 
Game Lands deer of either sex may be 
taken during the period November 30 
through December 3; and 
(I) Additional restrictions or modifications 
apply as indicated in parentheses follow- 
ing specific designations. 
Alexander and Caldwell Counties— Brushy 

Mountains Game Lands 
Anson County--Anson Game Land 
Ashe County--Bluff Mountain Game Lands 
Ashe County— Cherokee Game Lands 



Ashe and Watauga Counties— Elk Knob 
Game I_^nd 

Aver>', Buncombe, Burke, Caldwell, Hay- 
wood, Henderson, Jackson, Madison, 
McDoweU, Mitchell, Transylvania, Wa- 
tauga and Yancey Counties— Pisgah Game 
Lands (Harmon Den and Sherwood Bear 
Sanctuaries in Ha>'wood County are 
closed to hunting raccoon, opossum and 
wildcat. Training raccoon and opossum 
dogs is prohibited from March 1 to Octo- 
ber 1 1 in that part of Madison County 
north of the French Broad River, south 
of US 25-70 and west of SR 1319.) 

Beaufort, Bertie and Washington Coun- 
ties- -Bachelor Bay Game l^ands 

Beaufort and Pamlico Counties— Goose 
Creek Game Land 

Brunswick County--Green Swamp Game 
Land 

Burke County— South Mountains Game 
Lands 

Burke, McDowell and Rutherford Coun- 
ties--Dysartsville Game L-ands 

Caldwell County--Yadkin Game Land 

Carteret County Lukonr . Island Game Land 

Carteret, Craven and Jones Counties--Croa- 
tan Game Lands 

Chatham County--Chatham Game Land 

Chatham and Wake Counties— New Hope 
Game Lands 

Chatham and Wake Counties--Shearon 
Harris Game Land 

Cherokee, Clay, Graham, Jackson, Macon, 
Swain and Transylvania Counties--Nant- 
ahala Game Lands (It is unlawful to take 
or hunt deer on Fires Creek Bear Sanctu- 
ary. Raccoon and opossum may be 
hunted only from sunset Friday until 
sunrise on Saturday and from sunset until 
12;00 midnight on Saturday on Fires 
Creek Bear Sanctuary in Clay County and 
in that part of Cherokee County north of 
US 64 and NC 294, east of Persimmon 
Creek and Hiwassee Lake, south of Hi- 
wassee Lake and west of Nottely River; in 
the same part of Cherokee County dog 
training is prohibited from March 1 to 
October 11. It is unlawful to train dogs 
or allow dogs to run unleashed on Fires 
Creek Bear Sanctuary at any time, except 
that dogs may be used when hunting rac- 
coon or opossum and for hunting grouse 
and rabbits during the open seasons. It 
is unlawful to train dogs or allow dogs to 
run unleased on any game land in Gra- 
ham County between March 1 and Octo- 
ber 11.) 



964 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



Chowan County— Chowan Game I^and 
Cleveland County--Gardner-Webb Game 

I^nd 
Craven County— Neusc River Game land 
Craven County— I'uscarora CJamc I^and 
Currituck County— North River Game land 
Currituck County— Northwest River Marsh 

Game Land 
Dare County— Dare Game Land (No hunt- 
ing on posted parts of bombing range.) 
Davidson, Davie and Rowan Counties— Al- 
coa Game land 
Davidson County--Linwood Game Land 
Davidson, Montgomery, Randolph and 

Stanly Counties— Uwharrie Game Land 
Duplin and Fender Counties— Angola Bay 

Game land 
Durham, GranviUc and Wake Counties— 
Butner-Lalls of Neuse Game Land (On 
portions of the Butner-FaUs of Neuse 
Game Land designated and posted as 
"safety zones" and on thr' part marked 
as the Fenny Bend Rabbit Research Area 
no hunting is permitted. On portions 
posted as "restricted zones" hunting is 
limited to bow and arrow during the bow 
and arrow season and the regular gun 
season for deer.) 
Franklin County-- Franklin Game Lands 
Gates County--Chowan Swamp Game 

Land 
Granville County--Granvil]e Game Lands 
Halifax County-'Halifax Game Land 
Harnett County-- Harnett Game Land 
Henderson, Folk and Rutherford Coun- 

ties--Green River Game Lands 
Hyde County--Gull Rock Game Land 
Flyde County-- Fungo River Game Land 
Hyde and Tyrrell Counties-- New lake 

Game Land 
Jones and Onslow Counties— Hofmann 

Forest Game Land 
Lee County— Lee Game land 
McDowell County--Hickory Nut Mountain 

Game Land 
Moore County--Moore Game Land 
New Hanover County--Catrish Lake Game 

Land 
Northampton County--Northampton Game 

Land 
Orange County--Orange Game Land 
Ferson County-- Fcrson Game land 
Richmond County-- Richmond Game Land 
Transylvania County--Toxaway Game Land 
Vance County--Vance Game land 
Warren County-- Warren Game lands 
Wilkes County--I"hurmond Chatham Game 
Land 



Statutory Authority G.S. 113-134; J/3-264; 
1 13-291.2; 1 13-291.5; 113-305. 

TITLE 21 - OCCUPATIONAL LICENSING 
BOARDS 



ly otice is hereby given in accordance with G.S. 
I50B-I2 that the North Carolina Board of Nurs- 
ing intends to amend rule(s) cited as 21 NCAC 
36 .0213; adopt .0224 - .0227; and repeal .0222 - 
.0223. 

I he proposed effective date of this action is May 
I, 1989. 

1 he public hearing will be conducted at 10:00 
a.m. on February 17, J9S9 at Holiday Inn North, 
2815 North Boulevard, Raleigh, NC 27604. 

\^ omment Procedures: Any person wishing to 
address the board rele\-ant to proposed rules 
should notify the board by noon on February 16, 
1989, register at the door the day of the hearing, 
and present the Hearing Officer with a written 
copy of the oral testimony. Oral presentations will 
be limited to three minutes per speaker. Written 
comments only should be directed, five days prior 
to the hearing date, to the N.C. Board of .Cursing, 
P.O. Box 2129, Raleigh, NC 27602. 

CHAF'TER 36 - BOARD OF NURSING 
SECTION .0200 - LICENSURE 

.0213 REEXAMINATION 

(a) ¥fee An applicant chgjblc for reexamination 
must submit a completed application and the 
corr e ct current examination fee by the pubhshed 
deadline date for that examination session. 

(b) An applicant who was graduated boforo 
feiy 4-r 1981, aftd foik te- pass t4*e oxamination 
(m the fifs4- writing, may rewrite at cubooquunt 
examination fiof . nionr . . reestablishes eligibility for 
examination shall not he considered a first -time 
writer. 



(c) .\n applicant wh» wa^ graduated aftef fciy 
■1^ 1081 mu '. t pass the oxaminotion witliin three 
y e ars »f graduation ef roontor aft4 sucoouofuUy 
complete a board appro' i cd nursing program te 
be eligible t» take sub i jequent examinations, is 
only eligible to rewrite the examination for the 
level of licensure of the original examination ap- 
plication. 

(d) Successful completion trf a hoard approved 
nursing program requires that applicant must: 



NORTH CAROLINA REGISTER 



965 



PROPOSED RULES 



f4-)- Mu'L ' t yw curr e nt admi ' .ir . ion critoria ©f tfe» 
program te V i 'hich tw t» tiL ' L'king admif i sion. 
44it» applicant » free te choono afty 
board approsuJ program which prt-'parcs 
candidates fof Ae appropriate' lic e nsure 
examination; 
(5^ Aft e r t+H* current admi '^ sion/roadmif i oion, 
meet ^^e current cntena fof graduation 
from Ae program: 
fAr4 4-be nurse faculty must be ab4e te vali 
da4e t^^rri- t4*e applicant fras successfully 
met- the current criteria fe* aii nursing 
courses; 
fB) Validation ©f nursing courses which 
have a practicum component must ifi- 
clude clinical evaluation: 
{Q^ Validation ef required criteria must ae- 
company the transcript ' i i i 'liich must be 
submitted ' . sith tbe exainination applica 
tion. 
An applicant who wrote and failed the exam- 
ination prior to July j_^ 1981, shall not be re- 
el uircd to reestablish eligibility for examination. 
(e) An applicant who completes the require 
ments set- forth m Rul e . ( 1213 fd^ ¥riU be conoid 
efe4 a first time writer from tba* program, was 
graduated after .luly _K 19S1. must pass the ex- 
amination withm three \ears of graduation. The 
applicant who fails to pass the examination 
within three years of graduation must successfully 
complete a nursing program which has been ap- 
proNcd by the board as one to reestablish ehgi- 
bility for examination. The reestablished 

eligibility for examination shall be for three years. 
(t~) Aft applicant t+>f re examination k Het- ehgi 
bie fof a temporary license. A nursing program 
approved bv the board to reestabhsh eligibility is 
one: 

( 1) which is offered h\ or in conjunction with 
an existing nursing program approved bv 
the Board of Nursing and whose curric- 
ulum is designed to prepare graduates for 
registered nurse and or practical nurse lir 
censure as stipulated by APPROVAL OF 
M RSING I'ROGRAMS: PROCESS 
AND SrANDARi:)S (Section .0.^00 of 
these Rules): and 

(2) whose objectives competencies are in ac- 
cord with out-comes expected of an indi- 
vidual in nursing practice as legally 
defmed for licensure level; and 

(3) which has been submitted to the board for 
approval of the program's purposes, re- 
lated policies, and objectives competen- 
cies pnor to enrollment of applicants. 

(g) An applicant who successfully completes a 
nursing program approved bv the board to rees- 
tablish eligibility for exainination is eligible for a 



Status A temporary license. I'ligibilitv for a 
Status A temporary license will be restricted to 
once every three years. 

(h) Successful completion by an applicant of a 
nursing program approved bv the board to rees- 
tablish eligibility for examination requires that 
the faculty of the program or the applicant sub- 
mit evidence validating classroom and clinical 
competencies. 

Stalutoiy Authohlv G.S. 90-171.31. 



Mill COMPONENTS OF NURSING PRACTICE 

(REPE.\LED) 
.0223 CONTINUING EDUCATION PROGRAMS 

(REPEALED) 

Statutoiy Authority G.S. 90-17 1 .20(g)(h); 
90-171.42. 

.0224 COMPONENTS OF PRACTICE FOR 
THE REGISTERED NURSE 

(a) Nursing assessment is an ongoing process 
and consists of the determination of nursing care 
needs based upon collection and interpretation 
of data rele\'ant to the health status of a client. 

(1) CoUcction of data includes: 

(A) obtaining data from relesant sources 
regarding the biological, psychological, 
social and cultural factors of the client's 
life and the intluence these factors have 
on health status, including: 

(i) observations of appearance and be- 
havior; 

(ii) measurements of physical structure 
and physiologic function; 

(iii) information regarding available re- 
sources; and 

(B) \'erifying data collected. 

(2) Interpretation of data includes: 

(A) analyzing the nature and interrelation- 
ships of collected data; and 

(B) determining the significance of data to 
client's health status, ability to care for 
self, and treatment regimen. 

(3) Formulation of a nursing diagnosis in- 
cludes: 

(A) describing actual or potential responses 
to health conditions. Such responses are 
those for which nursing care is indicated, 
or for which referral to medical or com- 
munity resources is appropriate; and 

(B) developing a statement of a client 
problem identified tlirougli interpretation 
of collected data. 

(b) Planning nursing care activities include 
identifying the client's needs and selecting or 
modifying nursing interventions related to the 



966 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



findings of the nursing assessment. Components 
of planning include: 

(1) prioritizing nursing diagnosis or needs; 
\ (2) setting goals and outcome criteria; 

(3) initiating or participating in multidiscipli- 
nar>' planning; 

(4) determining and prioritizing nursing inter- 
ventions and actions; 

(5) developing a plan of care; and 

(6) identifying resources based on necessity 
and availability. 

(c) Implementation of nursing actions is the 
initiating and delivering of nursing care according 
to a specific plan which includes, but is not lim- 
ited to: 

( 1 ) procuring resources; 
' (2) actualizing nursing and medical orders; 
1 (3) performing nursing interventions; 

(4) analyzing responses to nunsing actions; 

(5) modifvLng nursing interventions; and 

' (6) delegating and supervising nursing actions 
commensurate with the preparation and 
qualifications of the individual consistent 
with G.S. 90- 17 1.20(g)(9); 21 NCAC 36 
.0224(e)(f); and 21 NCAC 36 .0401. 

(d) Evaluation consists of deteimining the ex- 
tent to which desired outcomes of care are met 
and planning for subsequent care. Components 
of evaluation include: 

(1) collecting evaluative data from relevant 
sources; 

(2) analyzing the effectiveness of nursing ac- 
tions; and 

(3) modifying the plan of care based upon 
newly collected data, change in the cUent's 
status, and expected outcomes. 

(e) Managing the deh\ery of nursing care 
through the ongoing supervision, teaching and 
evaluation of nursing personnel is the responsi- 
bility of the registered nurse as specified in the 
legal definition of the practice of nursing and in- 
cludes, but is not limited to: 

(1) continuous availability for direct partic- 
ipation in nursing care, on-site when nec- 

I essary, as indicated by clients' status and 

I by the variables cited in 21 NCAC 36 

I .0224(0; 

(2) assessing capabilities of personnel in re- 
lation to chent status and plan of nursing 
care; 

(3) delegating responsibility or assigning 
nursing care functions to personnel quali- 
fied to assume such responsibility and to 
perform such functions; 

(4) accountability for nursing care given by 
all personnel to whom that care is deleg- 
ated; and 



(5) direct observation of patients and evalu- 
ation of nursing care given. 

(f) The supervisory responsibility which a reg- 
istered nurse can safely accept is determined by 
the nurse's own qualifications and the variables 
in each nursing practice setting. The variables 
include: 

(1) the complexity and frequency of nursing 
care needed by a given client population; 

(2) the proximity of clients to personnel; 

(3) the qualifications and number of staff; 

(4) the accessible resources; and 

(5) established policies, procedures, practices, 
and channels of communication which 
lend support to the types of nursing ser- 
vices offered. 

(g) Reporting and recording by the registered 
nurse are those communications required in re- 
lation to all aspects of nursing care. 

(1) Reporting means the communication of 
significant information to other persons 
responsible for, or involved in, the care of 
the client. The registered nurse is ac- 
countable for: 

(A) directing the communication to the 
appropriate person(s); 

(B) commurucating uithin a time period 
which is consistent with the client's need 
for care; 

(C) evaluating any responses to information 
reported; and 

(D) determining whether further commu- 
nication is indicated. 

(2) Recording means the documentation of 
all significant information on the appro- 
priate client record, nursing care plan, or 
other documents. This documentation 
must: 

(A) be pertinent to the client's health care; 

(B) accurately describe all aspects of nursing 
care including assessment, planning, im- 
plementation, and evaluation; 

(C) be completed within a time period 
consistent with the client's need for care; 

(D) reflect the communication of significant 
information to other persons; and 

(E) verify the proper administration and 
disposal of controlled substances. 

(h) CoUaborating involves communicating and 
working cooperatively with indi\'iduals whose 
sen ices may have a direct or indirect effect upon 
the client's health care. The role of the registered 
nurse in collaborating in client care includes: 

(1) coordinating, planning, and implementing 
nursing or multidisciphnary approaches; 

(2) participating in decision-making and in 
cooperative goal-directed efforts; 



NORTH CAROLINA REGISTER 



967 



PROPOSED RULES 



(3) seeking and utilizing appropriate resources 
in the referral process; and 

(4) safeguarding confidentiality. 

(i) Teaching and counseling clients is the re- 
sponsibiUtv of the registered nurse, consistent 
with G.S. 90-171.20(g)(7). 

(1) Teaching and counseling consist of pro- 
\iding accurate and consistent informa- 
tion, demonstrations and guidance to 
clients and their families regarding the cli- 
ent's health status and health care for the 
purposes of: 

(A) increasing their knowledge; 

(B) assistmg the client to reach an optimum 
level of health functioning and partic- 
ipation in self care; and 

(C) promoting the client's ability to make 
informed decisions. 

(2) Teaching and counseling include, but are 
not limited to: 

(A) assessing the client's needs and abilities; 

(B) adapting teaching content and methods 
to the identified needs and abilities of the 
client(s); 

(C) evaluating effectiveness of teaching and 
counseling; and 

(D) making referrals to appropriate re- 
sources. 

(j) .Administering nursing ser\ices is the re- 
sponsibility of the registered nurse as specified in 
the legal definition of the practice of nursing in 
G.S. 90- 171.20(g)(9), and includes, but is not 
limited to; 

(1) identification of standards, policies and 
procedures related to the deli\'er>' of nurs- 
ing care; 

(2) planning for and evaluation of the nursing 
care delivery system; and 

(3) management of licensed and unlicensed 
personnel who pro\ide nursing care con- 
sistent with Paragraphs (e) and (f) of this 
Rule and which includes: 

(A ) defined levels of accountability and re- 
sponsibility within the nursing organiza- 
tion; 

(B) a mechanism to validate qualifications, 
knowledge, and skills of nursing person- 
nel; 

(C) provision of educational opportunities 
related to expected nursmg performance; 
and 

(D) validation of the implementation of a 
system for performance evaluation. 

Statutory Authority G.S. 90-17 1 .20(g). 

.0225 COMPONKNTS OF PR.ACTICE FOR 
THE LICENSED PR.\CTIC.\L NLRSE 



(a) Nursing assessment is an ongoing process 
and consists of the determination of nursing care 
needs based upon collection and interpretation 
of data relevant to the health status of a client. 

( 1 ) Collection of data includes: 

(A) obtaining data from relevant sources 
regarding the biological, psychological, 
social, and cultural factors of the client's 
life and the influence these factors ha\e 
on health status, including: 

(i) obser\ations of appearance and be- 
havior; 

(ii) measurements of physical structure 
and physiologic function; 

(iii) information regarding available re- 
sources; and 

(B) \erifying data collected. 

(2) Interpretation of data includes: 

(A) participation in the analysis of the na- 
ture and interrelationships of collected 
data: and 

(B) determining the significance of data to 
client's health status, ability to care for 
self, and treatment regimen. 

(3) Participation in the formulation of a 
nursing diagnosis consists of describing 
actual or potential responses to health 
conditions. Such responses are those for 
which nursing care is indicated, or for 
which referral to medical or community 
resources is appropriate. 

(b) Planning nursing care activities includes 
participation in the identification of cHent's needs 
and modification of nursing inter\-entions related 
to the findmgs of the nursing assessment. Com- 
ponents of planning include: 

(1) utilization of assessment data in making 
decisions regarding implementation of 
medical and nursing orders and plan of 
care; 

(2) participation in multidisciplinary plannmg 
by providmg resource data; and 

(3) identification of inter\'entions for review- 
by the registered nurse. 

(c) Implementation of nursing actions consists 
of deli\ering nursing care according to a specified 
plan under the direction of person(s) authorized 
by law, and includes: 

(1) procuring resources; 

(2) actualizing nursing and medical orders; 

(3) performing nursing inter\cntion5; 

(4) analyzing responses to nursing actions; 

(5) modifying nursing inten'entions; and 

(6) delegating and supervising nursing actions 
commensurate with the preparation and 
qualifications of the individual consistent 
with 21 NCAC 36 .0225(e) and 21 NCAC 
36.0401. 



96S 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(d) Evaluation, a component of implementing 
nursing actions, consists of participation in de- 
termining the extent to which desired outcomes 
of care are met and in planning for subsequent 
care. Components of evaluation include: 

(1) collecting evaluative data from relevant 
sources; 

(2) determining the effectiveness of nursing 
actions; and 

(3) proposing modifications to the plan of 
care based upon newly collected data, 
change in the client's status, and expected 
outcomes. 

(e) The licensed practical nurse may implement 
nursing care by delegating nursing care activities 
to other licensed practical nurses and unhcensed 
personnel appropriate to the level of knowledge 
and skills of personnel to whom care is delegated 
and providing all of the following criteria are met: 

(1) continuous availability of a registered 
nurse for super\'ision consistent with 21 
NCAC 36 .0224(e); 

(2) participation by the licensed practical 
nurse in observations of clients and eval- 
uation of nursing actions; 

(3) retention of accountability by the licensed 
practical nurse for nursing care given by 
self and all other personnel to whom such 
care is delegated; and 

(4) provision of appropriate supervision as 
determined by the variables in each nurs- 
ing practice setting. The variables include: 

(A) the complexity and frequency of nurs- 
ing care needed by a given client popu- 
lation; 

(B) the proximity of clients to personnel; 

(C) the qualifications and number of staff; 

(D) the accessible resources; and 

(E) established policies, procedures, prac- 
tices, and channels of communication 
which lend support to the types of nursing 
services offered. 

(f) Reporting and recording by the licensed 
practical nurse are those communications re- 
quired in relation to all aspects of nursing care. 

(1) Reporting means the communication of 
significant inlbrmation to other persons 
responsible for, or involved in, the care of 
the client. The licensed practical nurse is 
accountable for: 

(A) directing the communication to the 
appropriate person(s); 

(B) communicating within a time period 
which is consistent with the client's need 
for care; 

(C) evaluating any responses to information 
reported; and 



(D) determining whether further commu- 
nication is indicated. 
(2) Recording means the documentation of 
all significant information on the appro- 
priate client record, nursing care plan or 
other documents. This documentation 
must: 

(A) be pertinent to the client's health care; 

(B) accurately describe all aspects of nursing 
care including assessment, planning, im- 
plementation, and evaluation; 

(C) be completed within a time period 
consistent with the client's need for care; 

(D) reflect the communication of significant 
information to other persons; and 

(E) verify the proper administration and 
disposal of controlled substances. 

(g) Collaborating involves communicating and 
working cooperatively in implementing the 
health care plan with individuals whose services 
may have a direct or indirect effect upon the cU- 
ent's health care. The licensed practical nurse's 
role in coUaborating in client care includes: 

(1) participating in planning and implement- 
ing nursing or multidisciplinary ap- 
proaches; 

(2) participating in decision-making and in 
cooperative goal-directed efforts; 

(3) seeking and utilizing appropriate resources 
in the referral process; and 

(4) safeguarding confidcntiahty. 

(h) The licensed practical nurse provides 
teaching and counseling to clients consistent with 
G.S. 9d'-171.20(h)(3)(4). 

(1) Teaching and counseling consist of pro- 
viding accurate and consistent informa- 
tion, demonstrations, and guidance to 
clients and their families regarding the cli- 
ent's health status and health care for the 
purposes of: 

(A) increasing their knowledge; 

(B) assisting the client to reach an optimum 
level of health functioning and partic- 
ipation in self care; and 

(C) promoting the client's ability to make 
informed decisions. 

(2) Teaching and counseling as part of imple- 
menting the health care plan includes, but 
is not limited to: 

(A) assessing the client's needs and abilities; 

(B) participating in the teaching and coun- 
seling process; 

(C) evaluating the effectiveness of teaching 
and counseling; and 

(D) making referrals to appropriate re- 
sources. 

Statuioiy Authority G.S. 90-17 1.20(h). 



NORTH CAROLINA REGISTER 



969 



PROPOSED RULES 



.0226 RF.SFRVFD FOR FL1 LRE 
CODIFKAIION 

.0227 CONTIMING EDLCATION 
PROGRAMS 

(a) Definitions. 

(1) Continuing education in nursing is a non- 
degree oriented, planned, organized learn- 
ing experience taken after completion of 
a basic nursing program. 

(2) Programs offering an educational experi- 
ence designed to enhance the practice of 
nursing are those which include one or 
more of the following: 

(A) enrichment of knowledge; 

(B) de\elopment or change of attitudes; 

(C) acquisition or improvement of skills. 

(3) Programs are considered to teach nurses 
advanced skLUs when: 

(A) the skill is not generally included in the 
basic educational preparation of the nurse; 
and 

(B) the period of instruction is sufficient to 
assess or provide necessary" knowledge 
from the physical, biological, behavioral 
and social sciences, and includes super- 
vised clinical practice to ensure that the 
nurse is able to practice the skiU safely and 
properly. 

(4) Student status may be granted to indi\id- 
uals who do not hold a North Carolina 
nursing license but who participate in 
continuing education programs in North 
Carolina when: 

(A) The individual possesses a current un- 
encumbered license to practice nursing in 
a jurisdiction other than North Carolina; 
and 

(B) The course offering is approved by the 
board; and 

(C) 'The individual receives supervision by 
a qualified member of the faculty who has 
a valid license to practice as a registered 
nurse in North Carolina; and 

(D) The course of instruction has a speci- 
fied period of time not exceeding 12 
months; and 

(E) There is no provision for employment 
of the "student"; and 

(F) The board has been gi\en advance no- 
tice of the names of the students, the ju- 
risdictions in which they are licensed, the 
license numbers, and the expiration dates. 

(b) Guidelines for \oluntar\' approval of con- 
tinuing education programs in nursing. 

(1) Planning shall include: 



(A) definition of learner population; for 
example, registered nurse, hcensed practi- 
cal nurse, or both; 

(B| identification of characteristics of the 
learner; for example, clinical area, place 
of employment, position; and 

(C) assessment of needs of the learner; for 
example, requests, questionnaire, chart 
audit. 

(2) Objectives shall: 

(A) be measurable and in behavioral terms; 

(B) reflect needs of learners; 

(C) state desired outcomes; 

(D) serve as criteria for selection of content, 
learning experiences and evaluation of 
achievement; 

(E) be achievable within time allotted; and 

(F) be applicable to nursing. 

(3) Content shall: 

(A) relate to objectives; 

(B) reflect input by qualified faculty; and 

(C) contain learning experiences appropri- 
ate to objectives. 

(4) Teaching methodologies shall: 

(A) utiUze pertinent educational principles; 

(B) provide adequate time for each learning 
activity; and 

(C) include sharing objectives with partic- 
ipants. 

(5) Resources shall iaclude: 

(A) faculty who have knowledge and expe- 
rience necessary to assist the learner to 
meet the program objectives and are in 
sufficient number not to exceed a facul- 
ty-learner ratio in clinical practicum of 1: 
10. If higher ratios are desired, sufficient 
justification must be provided; 

(B) physical facilities which ensure that ad- 
equate and appropriate equipment and 
space are available and appropriate clin- 
ical resources are a\ailable. 

(6) Evaluation will be conducted: 

(A) by the provider to assess the partic- 
ipant's achievement of program objectives 
and content and will be documented; and 

(B) by the learner in order to assess the 
program and resources. 

(7) Records shall be maintained by the pro- 
\ider for a period of three \ ears and shall 
include a summary of program evalu- 
ations, roster of participants, and course 
outline. The provider shall award a cer- 
tificate to each participant who success- 
fully completes the program. 

(c) Approval process. 
(1) The provider shall: 



970 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(A) make application on forms provided 
by the board no less than 60 days prior to 
the proposed enrollment date; 

(B) present evidence as specified in 21 
NCAC 36 .0227 (b); 

(C) notify the board of any significant 
changes relative to the maintenance of 
guidelines; for example, changes in fac- 
ulty, total program hours. 

(2) Approval is granted for a two-year period. 
Any request to offer an approved program 
by anyone other than the original provider 
must be made to the North Carolina 
Board of Nursing. 

(3) If a course is not approved, the provider 
may appeal in writing for reconsideration 
within 30 days after notification of the di- 
sapproval. If the course is not approved 
upon reconsideration, the provider may 
request a hearing at the next regularly 
scheduled meeting of the board. 

(4) Site visits may be made by the board as 
deemed appropriate to determine compli- 
ance with the guidelines. 

(5) The board shall withdraw approval from 
a provider if the provider does not main- 
tain the quality of the offering to the sat- 
isfaction of the board or if there is 
misrepresentation of facts within the ap- 
plication for approval. 

(6) Approval of continuing education pro- 
grams will be included in published re- 
ports of board actions. A list of approved 
programs will be maintained in the 
board's file. 

Statutory Authority G.S. 90-171.42. 

TITLE 25 - OFFICE OF STATE 
PERSONTSEL 

l\ otice is hereby given in accordance with G.S. 
I SOB- 1 2 that the Office State Personnel! State 
Personnel Commission intends to amend rule(s) 
cited as 25 NCAC ID .0301 - .0302, .1201 - .1204, 
IE .1005, II .0706 - .0707, IJ .0402, .0406 and 
.0407. 

1 he proposed effecth'e dates of this action are 
25 NCAC ID .1201 - .1204 - July I, I9S9, all 
others May I, I9S9. 

1 he public hearing will be conducted at 9:00 
a.m. on Februarv 15, 1989 at 101 W. Peace 
Street, Raleigh, N. C. 27611. 



Co 



■ omment Procedures: Interested persons map 
present statements orally or in writing at the 
hearing or in writing prior to the hearing by mail 
addressed to: Drake Maynard. Office State 
Personnel, 116 W. Jones Street, Raleigh, N. C. 
27611. 

CHAPTER I - OFFICE OF STATE PERSONNEL 

SUBCHAPTER ID - COMPENSATION 

SECTION .0300 - PROMOTION 

.0301 DEFINITION AND POLICY 

Promotion is a change in status upward, docu- 
mented according to customars' professional 
procedure and approved by the State Personnel 
Director, resulting from assignment to a position 
of higher level. When it is practical and feasible, 
a vacancy should be filled from among A« eligi- 
ble pormanont employees; a vacancy must be 
filled bv an applying employee if required by 25 
NC.'\C, Subchapter 111, Recruitment and Se- 
lection, Section .0600, Cjeneral Provisions, Rule 
.0625, Promotion Priority Consideration for 



Current l:mployees. Selection should be based 
upon demonstrated capacity, quality and length 
of ser\'ice. 

Statutoty Authority G.S. 126-4; 126-7. 1. 

.0302 SALARY RATE 

The purpose of a promotional pay increase is 
to reward the employee for the assumption of 
duties more responsible and more difficult than 
those in the current position. The primary factor 
dotormining ttt» amount ©f incr e ar . o i* t4*e rolativo 
differ e nc e ift difficulty aft4 rof . ponsibility bot' i voon 
th* pr e f .e nt af(4 Rew pof . itions. Sinco promo 
tional increasBG recult m pormanont ohango te 
basic r . alapy, a promotional incroano &f moro than 
twO' C i topn cannot be juF . tifi e d as a» offset te- torn 
porapy coc . ts ©f promotion, cuch as relocation 
oxponooo. Subject to the availability of funds, the 
following will apply: 
(1) Pennanent Promotion: 
(a) The salarv' shall be increased to step one 
or by one step whichever is larger, but not 
to exceed the maximum of the higher 
range, shall ftet- t»e oxcoodod. Exceptions: 
(i) When internal salary equity or budget 
considerations in the rccei\'ing work unit 
or agency are necessary, and a specific sa- 
lars' rate is published in advance of a pro- 
motional offer; 
(ii) When an employee is demoted with no 
change in salary and subsequently pro- 
moted back to the same level within one 



NORTH CAROLINA REGISTER 



971 



PROPOSED RULES 



year, the salary shall remain unchanged 
and treated as if the demotion had not 
occurred; 



(iii) V[ the employee's salary' is above the 
maximum as a result of a reallocation 
down, no increase may be aven but the 
salary' may remain above the maximum. 

(i^ (b2 If a probationary' employee is promoted 
and the salary is at the hiring rate, the sa- 
lary must be increased to the hiring rate 
of the grade to which promoted until the 
employee is eligible for permanent ap- 
pointment. 

(ii^ (c) If the employee is to receive a perform- 
ance salary' increase on the same date as 
the promotion, the increase may be given 
before the promotional increase. 

(fe) (d} The salar,' may be mcreased by e«e aft4 
one half r . tepji e* twe ctopo more than one 
step, not to exceed the number of salary 
grades provided by th£ promotion. The 
nature and magnitude of the change in 
jobs, the need to maintain equity of sala- 
rics within the work unit, and other man- 



agement 



needs 



must 



given 



H 



(£1 



consideration uhen makmg such requests. 
Only m extreme, well-documented cir- 
cumstances will salary increases be con- 
sidered which equate to more steps than 
the number of grades provided by the 
promotion. Personnel forms must in- 
clude the justification. 
U ilw agency findo jt- neceooar i ' aft4 equi 
tabla ygf conoidor a larger incroano fof a 
promotion in' i ohing a throe e* mor e 
grad e level change, a ' ' . alar/ increauo ef 
more than twe atepo may be roquoated. 
Some factorr . t© be conoidered afe^ nature 
aH4 magnitude ef Ae chang e m ]oh>y, 
a' i 'ailabl e applicant n; r i pocial ef teohnioal 
expertif i o required; aR4 proviouo training 
aft4 OKporienco. Such roquer . tf i H»y be 
made pros'lded: 

fi^ The agency head accepts accountability 
ft» t+te decision (4 Ae amount te grant 
aft4 Vi+H- provid e written documentation 
giving reaoons aft4 justification ffH= the Fe- 
quosts. 

fii^ Salar i f inequiti e s afe ftet- created within 
the ' ■ ' ■ 'ork tmit- e* program. 
Since promotional increases result in per- 
manent change to basic salary^ a larger 



promotional increase cannot be justified 
as an offset to temporary costs of pro- 
motion, such as relocation expenses. 

Siatutofy Authority G.S. 126-4. 



SECTION .1200 - LONGEVITY PAY 

.1201 POLICY 

Longevity pay is to recognize long-term service 
of permanent full-time and permanent part-time 
(half-time or more) employees who have served 
at least 10 years with the state. 

Statutory Authority G.S. 126-4. 

.1202 TIME AND METHOD OF PAY 

(e) If an employee who has at least 10 years of 
aggregate total state service retires, resigns or is 
otherwise separated or dies before a date on 
which eligible for the longevity payment, a lon- 
gevity payment computed on a pro rata basis 
shall be paid if aU other ehgibility requirements 
are met. The payment shall be made to the em- 
ployee or to the estate if deceased. 

(g) If an cligihle employee goes on extended 
military' leave without pay, a longevity payment 
computed on a prorata basis shall be paid the 
same as if the employee is separating. The bal- 
ance wtU be paid when the employee returns and 
completes a fuU year. Then, a fuU payment wiU 
be made on the employee's longevity date that 
was established before going on leave without 
pay. (Example: Received longevity on 6-1-85 
on 1 1 years; extended military leave without pay 
on 9-1-85 (pay 3/12 longevity on 12 years'); rein- 
stated on 12-1-86; pay 9/12 longevity effective 
9-1-87 on 13 years (has 13 years 3 months ag- 
gregato total state service); pay full longevity ef- 
fective 6-1-88 on 14 years.) 

Statutory Authority G.S. 126-4. 

.1203 AMOLNT OF LONGEVITY PAY 

(a) Annual longevity pay amounts are based 
on the length of aggregate total state service and 
a percentage of the employee's annual rate of 
base pay on the date of ehgibnity. Longevity pay 
amounts are computed by multiplying the em- 
ployee's base pay rate by the appropriate per- 
centage from the following table. (Salary 
increases effective on the longevity eligibility date 
shall be incorporated in the base pay before 
computing longevity.) 
Years of Aggregate Total 

State Ser,'ice Longevity Pay Rate 

10 but less than 15 years 1.50 percent 

15 but less than 20 years 2.25 percent 

20 but less than 25 years 3.25 percent 

25 or more years 4.50 percent 

Statutory Authority G.S. 126-4. 

.1204 ELIGIBILITY REQLIREMENTS 



972 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



(a) An employee shall have at least 10 years of 
aguTL ' gat e total qualifying state scnice before be- 
ing eligible for any longevity payments. 

(c) An employee's earliest possible date of el- 
igibility for a longevity payment is the date when 
10 years of aggro gat o total state ser\'ice has been 
completed. If on the effective date of this policy 
an employee has completed the qualifying length 
of service but is somewhere between eligibility 
dates, longevity payment will not be made until 
the next longevity anniversary' date. In succeed- 
ing years a longevity payment will be made an- 
nually in the pay period in which the employee's 
longevity anniversary date falls. Periods of leave 
without pay in excess of one-half the workdays 
and holidays in a pay period (with the exception 
of military leave and workers' compensation 
lea\'e) will delay the longevity annivcrsarv' date. 

(d) Credit for the aggrugato total service re- 
quirement shall not be given for temporary full- 
time or temporary part-time employment and 
periods of lca\'e without pay in excess of one-half 
the workdays and holidays in a pay period, with 
the exception of military' leave and workers' 
compensation leave. 

(e) Upon change of appointment to temporan,' 
part time? or exempt (except as pro\'ided by stat- 
ute), the employee is ineligible for continued 
longevity pay: hence, if the employee has worked 
part but not all of one year since the last annual 
longevity payment, a prorata payment shall be 
made as if the employee were separating from 
state service, provided the change is not of a 
temporary' nature. If an employee goes on leave 
without pay, longe\'ity shall not be paid until the 
employee returns and completes the full year. If, 
however, the employee should resign whUe on 
leave without pay, the prorata amount for which 
the employee is eligible is paid. Exceptions: 

(1) An employee going on leave without pay 
due to short-term disability may be paid 
the prorata amount for which the em- 
ployee is eligible; 

(2) An employee going on extended military 
leave without pay shall be paid the prorata 
amount for wliich eligible; 

(3) An employee on workers' compensation 
leave shall be paid longevity as if working. 

(g) Aggrogato Total state service is the time fof 
of full-time or part-time (half-time or over) per- 
manent, trainee, probationan,' or proN'isional 
employment, whether subject to or exempt from 
the State Personnel Act. If » an p e rman e nt full 
tefte employee so appointed is in pay status or 
is on authorized mihtary leave for one-half of the 
regularly scheduled workdays and holidays in a 
in a pay penod, credit shall be gi\'en for the entire 
pay period. Pormanont part time employm e nt 



is cr e dited as aggregat e j ien'ic e »«• a pfe^ Fate baria 
- J* is computed as a percentag e »f tlw amount 
y*e employee vsould bt» cr e dit e d if perman e nt 
full time. Hmployees will receive full credit for 
each pay penod they arc in pay status for one- 
half of their regularly scheduled workdays and 
holidays. 

Statutory Authority G.S. 126-4. 

SUBCHAPTER IE - EMPLOYEE BENEFITS 

SECTION .1000 - MISCELLANEOUS LEAVE 

.1005 LEAVE: AD\ ERSE WEATHER 
CONDITIONS 

(a) The following policy will apply >' i 'hen d e ci 
sions muot h^ made te- either continue »f tem 
porarily c . ucpond r f OP i icofi as a rooult ©f adverce 
weather condition ' !. 1 he geographical location 
and diversity of state services and programs make 
it impossible to apply a uniform statewide policy 
regarding how operations will be affected in times 
of ad\ersc weather conditions. 

?4*e Governor ift 



^ 



ill 



Within W'alco County, 
cooperation with t+h* QtTic e ef State Pt^^ 
oonnel w+11 detenntne »fi4 announce when 
admini^ . trative officef i i» Wake County 
will b^ clor . ed 4t** te advorso weather. -It- 
is recognii'.ed t4«4- f i ome operationr . mu ' it 
continue te- provide c . ep i ic e s without re- 
gard te- weather conditions. Therefore, 
agency heado will predetermin e aft4 dooig 
Rate tl+e mandatory operations which will 
remain open. 

The administrati\'e offices of State Gov- 
ernment in Wake County must be open 
during normal business hours to serve lo- 
cal go\'eniments and the citizens of .North 
Carolina and to provide support services 
to business and industry'. These offices 
will remain open, even in adverse weather, 
and it b the responsibHitv of employees 
to make a good faith ctTort to come to 
work dunng these times. 



(54 Areas Outside Wak e County. /Ngency 
heads. &f their designated repreoentati' i os, 
will detennine Ae operations tl*at- will Fe- 
main open afwl to- ' ■ ' . hat extent other Bp- 
erations tway be temporarily closed. 

(2) It is recognized that some other operations 
in and out of Wake County must con- 
tinue to provide senices without regard to 
weather conditions. Therefore, agency 
heads shall predetermine and designate the 
mandatory' operations which will remain 
open. .Agency heads, or their designated 
rcpresentati\'es, may determine to what 



NORTH CAROLINA REGISTER 



973 



PROPOSED RULES 



extent any other operations may be sus- 
pended or temporanlv closed. 
(b) When it has been determined that services 
will be suspended, time lost will be charged to 
vacation leave or leave without pav. W ofTicoQ 



r e main open. I'mployees, not working in man- 
datory' operations, who anticipate problems in 
transportation should be permitted and encour- 
aged to adjufit their work F i chcdult' v>+h*» pooniblo 
e* to- avail themselves of vacation leave privileges 
when encountering difficulty in reporting for 
work or when leaving early. 

In either of the above, employees may be al- 
lowed to make-up time in accordance with this 
Rule. 

Ivmployees who are on prearranged vacation 
leave or on sick leave will charge leave to the 
appropriate account with no provision for 
make-up time. 

(c) When employees are away from work be- 
cause of adverse weather conditions, where op- 
erational needs allow, management ««¥■ must „ , , , ^ r^ ,^^ , . . , ,^, 
make evcrN' reasonable effect to arrange sched^Iki Statulon' Authority G.S. 126-40). (10). 



(d) Special Provision. When catastrophic, 
life-threatening weather conditions occur, as cre- 
ated by hurricanes, tornadoes, or Hoods, and it 
becomes necessan^ for authorities to order evac- 
uation from the place of employment, the fol- 
lowing provisions vsill prevail: 

( 1 ) bmploN'ees who arc required to evacuate 
will not be required to make up time that 
is lost from uork during the penod offi- 
ciall\' declared hazardous to life and safety. 
I-.mployees required to remain at work 
may he relieved administratively for a pe- 
riod of time necessary to assure the safety 
of their family. 

(2) Employees required to work in such 
emergency situations will be paid in ac- 
cordance uith the State's policy on Hours 
of Work and Overtime Compensation. 
l'"verv effort should be made to compen- 
sate overtime by additional payment 
rather than compensatory- time. 



whereby emplo>ees muv will be given an oppor- 
tunity to make up time not worked (either when 
ser\'ices are suspended for the general public or 
by voluntar* action of the employee, such as 
working extra hours in work weeks shortened by 
holidays, vacations, illness or other absences so 
that such make up time does not result in any 
event in the employee 4et» »»*• ' ■ ' ■• ork working 
more than forty hours in any work week) rather 
than charging it to leave. 

There are very few opportunities for such time 
to be made up without the employee working 
more than forty hours during a work week. 
Sinco the opportunity \» mak e Hf> t4*e time kw4 
» * ben e fit fof tl*e employee, it- v4y be permiooi 
bier therefore, f»f such makeup tim e t» occur m 
oxoosD (rf forty hours tft » work' i s'ook without Ae 
time being oubjoot to overtime componnation. 
provided tha* t4*e employee hi*s requ e st e d Ae 
opportunity te- mak e »f» l»*t- tim e oubject te- the 
condition that- ov e rtim e compenoation ¥riU SBt- 
be made. Since hours worked in excess of 40 
during a workweek would constitute overtime 
under f'ederal regulations, h will be necessary- for 
make-up time for employees subject to overtime 
compensation to be limited to the workweek in 
which the time is lost or in a week when the 
employee has not vsorked a fuU work schedule 
due to such absences as hcilidavs, vacation, sick 
leave, ci\il leave, etc. Time must be made up 
withm 12 months from the occurrence of the 
absence. If it is not made up within 12 months, 
vacation leave must be charged, or leave without 
pay taken. 



SLBCIIAPTF.R II - SERVICE TO LOCAL 
GONERNMENT 

SECTION .0700 - APPOINTMENT AND 
SEPARAIION 

.0706 DEMOTION 

A demotion » » chang e i» clasoification to a 
lower level. Demotion or reassignment is a 
change in status resulting from assignment of a 
position to a lower classification level. It may 
result from the choice of the employee, reallo- 
cation of a position, inefticiency in performance, 
unacceptable conduct, reduction-in-force, or bet- 
ter utilization of individual resources. If the 
change results from inefficiency in performance 
or as a disciplinarN' action, the action is consid- 
ered a demotion. If the change results from a 
mutually a.greed upon arrangement, the action is 
considered a reassignment. When an employee 
in permanent, probationary, or trainee status is 
demoted, it is expected that he wiU possess the 
minimum qualifications required for the new 
class at the respective level of appointment. 

Statutory Authority G.S. 126-4. 

.0707 SEPARATION 

(3) For reasons ot curtailment of work, reor- 
ganization, or lack of funds the appointing 
authority may separate employees. Re- 
tention of employees in classes affected 
shall be based on systematic consideration 
of type of appointment, length of service, 



974 



NORTH CAROLINA REGISTER 



PROPOSED RULES 



and relative efTicicncy. No permanent 
employee shall be separated while there 
are emergency, intermittent, temporary, 
probationar)', or trainee employees in 
their initial six months of the trainee pro- 
gression ser\ing in the same or related 
class, unless the permanent employee is 
not willing to transfer to the position held 
by the non-permanent employee, or the 
permanent employee does not ha\e the 
knowledge and skills required to perform 
the work of the alternate position within 
a reasonable period of orientation and 
training given any new employee. 

Statutory Authority G.S. J 26-4. 

SLBCHAPTER IJ - EMPLOYEE RELATIONS 



(a) Awards will be presented on the basis of an 
employee's aggrogato total state service. 

(b) Aggrogato Total state scr\'icc is the time fof 
of full-time or part-time (half-time or over) per- 
manent, trainee, probationary or provisional 
employment, whether subject to or exempt from 
the State Personnel Act. If a pormanont full timo 
an employee so appointed is in pay status or is 
on authorized military leave for one-half of the 
regularly scheduled workdays and holidays in a 
pay period, credit shall be given for the entire pay 
period. Ponnanont part timo omploymont i« 
croditod as aggrogato DOP i ioo »» a pre Fatr* basis - 
it » oomputod as a porcontago »f A» amount tfee 
employoo would b© croditod if pormanont foH- 

Stalutory Authority G.S. 126-4(10). 



SECTION .0400 - SERVICE AWARDS 
PROGRAM 

.0402 POLICY, SERMCE .WVARDS PROGRAM 

The service awards program is designed to rec- 
ognize full-time and part-time (20 hours or more) 
permanent employees. On each fdth anniversary 
of employment with the State of North Carolina, 
the state will present the employee with an em- 
blem mounted as fme jewelry. The two-piece 
design emblem is made of an antiqued yellow 
gold-filled crest mounted on a white gold base. 
Jewels on the design indicate the number of years 
of ser\ice; the designation being as follows: 



five years of service 
10 years of service . 
1 5 years of service . 
20 years of service . 
25 years of service . 
30 years of service . 

35 years of service . 

40 years of service . 

45 years of service . 
50 years of service . 



. one ruby 

two rubies 

three rubies 

three blue sapphires 

three emeralds 

one full-cut diamond 

and two rubies 

one fuU-cut diamond 

and two emeralds 

two full-cut diamonds 

and one ruby 

tliree fuU-cut diamonds 

four full-cut diamonds 



Statutory Authority G.S. J 26-4. 

.0406 ELIGIBILITY REQLIREMENTS 



.0407 ADDITIONAL CREDIT 

Credit fep ttw* aggrogato toward total state ser- 
vice requiromont alse shall also be given for the 
following: 

(1) employment with other governmental units 
which are no\\' state agencies (Example: 
county highway maintenance forces. War 
Manpower Commission, judicial system); 

(2) authorized miUtarv' leave from any of the 
governmental units for which service credit 
is granted, provided the employee is rein- 
stated within the time hmits outlined in the 
state military leave policies; 

(3) employment with the county agricultural 
extension service, community college system 
and the pubhc school system of North Ca- 
rolina, with the provision that a school year 
is equivalent to one fuU year; 

(4) employment with a local mental health, 
public health, social ser\'ices. or emergency 
management agency in North Carolina if 
such employment is subject to the State 
Personnel Act; 

(5) employment with the General Assembly 
(except for participants in the Legislative 
Intem Program and pages). All of the time, 
both permanent and temporarv', of the em- 
ployees will be counted; and the full legisla- 
tive terms of the members. 

Statutory Authority G.S. l26-4( 10). 



NORTH CAROLINA REGISTER 



975 



LIST OF RULES AFFECTED 



NORTH CAROLINA ADMIMSTRAITV E CODE 
EFFECTIVE: January I, 1989 



AGENCY 






DEPARTMENT OF- AGRICl 


ITLRE 




2 NCAC 34 


.0102 
,0204 






.0301 - 


.0302 




.0309 






.0317- 


.0318 




.0321 






.0325 






.0328 






.0401 - 


.0402 




.0405 






.0501 






.0503 






.0505 






.0601 






.0603 - 


.0605 




.0701 - 


.0703 




.0803 






.0805 - 


.0806 




.0902 






.0904 






.1001 






.1103 




48A 


.0611 




52B 


.0207 




52C 


.0105 




DEPARTMENT OF MIM AN 


RESOl 


RCES 


10 NCAC 3A 


.0101 - 


.0102 




.0201 - 


.0202 




.0203 






.0204 - 


.0205 




.0301 - 


.0302 




.0501 - 


.0502 




.0601 - 


.0602 




.0603 - 


.0604 




.0605 






.0606 






.0607 - 


.0608 




.0609 - 


.0610 




.0701 - 


.0703 




.0801 - 


.0804 




.0901 - 


.0902 




.1001 - 


.1002 




.1101 - 


.1102 




.1201 - 


.1203 


3R 


.1003 




lOA 


.2115 
.2117 
.2120 





ACTION TAKEN 



Amended 
Repealed 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Amended 
Adopted 



Amended 

Amended 

Repealed 

Adopted 

Amended 

Amended 

Amended 

Repealed 

Amended 

Repealed 

Amended 

Adopted 

Repealed 

Adopted 

Adopted 

Adopted 

Adopted 

Adopted 

Amended 

Amended 

Repealed 

Repealed 



976 



NORTH CAROLINA REGISTER 



LIST OF RULES AFFECTED 



,2121 - .2124 

.2126- .2131 

.2132 
14C .0704 

.0709 
15A .0601 - .0607 
18A .0131 
30 .0214 
42C .2401 
45H .0202 

.0205 
49B .0304 

.0306 



Amended 

Amended 

Repealed 

Amended 

Amended 

Adopted 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



DEPARTMENT OF INSURANCE 



11 



NCAC 10 



HE 



.0202 
.0301 
.0306 
.0308 
.0312 
.0402 
.0404 
.0501 
.0601 
.0604 
.0701 
.0703 
.0801 
.0805 
.0806 
.0901 
.0905 
.0906 
.1001 
.1005 
.1006 
.1101 
.1106 
.1201 
.1301 
.1401 
.0110 



.0209 
.0304 



.0405 
.0505 
.0603 



.0705 
.0804 



- .0903 

- .0907 

- .1003 

- .1007 

- .1103 

- .1207 

- .1302 

- .1402 



Repealed 

Repealed 

Amended 

Amended 

Repealed 

Amended 

Repealed 

Repealed 

Amended 

Repealed 

Amended 

Amended 

Amended 

Repealed 

Adopted 

Amended 

Repealed 

Adopted 

Amended 

Repealed 

Adopted 

Adopted 

Adopted 

Adopted 

Adopted 

Adopted 

Adopted 



DEPARTIVIENT OF JUSTICE 



12 NCAC lOA .0101 - .0105 

.0201 - .0208 
.0301 - .0302 
.0401 - .0408 
.0501 - .0503 
.0601 - .0606 
.0701 - .0705 
.0801 - .0807 
.0901 - .0903 
.1001 - .1007 
.1101 - .1104 
.1201 
.1301 - .1308 



Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 
Repealed 



NORTH CAROLINA REGISTER 



977 



UST OF RULES AFFECTED 



.1401 - 


.1408 


Repealed 


.1501 




Repealed 


.1601 




Repealed 


lOB .0101 - 


.0104 


Adopted 


.0105 




Adopted 


.0201 - 


.0203 


Adopted 


.0301 - 


.0308 


Adopted 


.0401 - 


.0408 


Adopted 


.0501 - 


.0509 


Adopted 


.0601 - 


.0607 


Adopted 


.0701 - 


.0707 


Adopted 


.0801 - 


.0803 


Adopted 


.0901 - 


.0909 


Adopted 


.1001 - 


.1006 


Adopted 


.1101 - 


.1105 


Adopted 


.2001 - 


.2002 


Adopted 


.2101 - 


.2105 


Adopted 


DF.PARTMFNT OF N.ATLR.AL RESOl RCES AND COMMUNITY DEVELOPMENT 


15 NCAC 7H .1105 




.\mended 


7J .0303 




Amended 


.0409 




Amended 


.0604 




Adopted 


10B.0115 




Amended 


IOC .0407 




Temp. .Amended 
Expires 06-26-89 


lOF .0305 




.Amended 


.0313 




.Amended 


.0340 




Amended 


.0352 




.Amended 


13L .0907 




.-\mended 


16C.0113 




Adopted 


16D.0201 




Amended 


DEPARTMENT OF REVENUE 






17 NCAC IC .0402 




Amended 


6C .0104 




Amended 


SECRETARY OF STATE 






18 NCAC 6 .1701 - 


.1714 


Temp, .-\dopted 
Expires 06-30-89 


.1801 - 


.1811 


Temp. Adopted 
Expires 06-30-89 


BOARD OF CERTIFIED PI BI IC ACCOUNTANT EXAMINERS 




21 NCAC 8G .0402 




.Amended 


BOARD OF CHIROPRACTIC EXAMINERS 




21 NCAC 10 .0202 




Amended 


.0607 - 


.0608 


.rVmended 


.0611 




.Adopted 


.0705 




Repealed 


.0706 




.-Vmended 



978 



NORTH CAROLINA REGISTER 



LIST OF RULES AFFECTED 



BOARD OF COSMETIC ART EXAMINERS 



21 


NCAC 14A 


.0101 
.0102 
.0103- .0105 




14B 


.0101 - .0102 

.0105 

.0107 

.0201 

.0302 

.0303 

.0304 - .0305 

.0308 - .0309 

.0501 - .0503 

.0506 

.0507 

.0601 

.0602 




14C 


.0101 

.0103 

.0203 

.0205 

.0401 - .0402 

.0503 

.0504 

.0601 

.0602 

.0801 - .0803 

.0805 

.0806 

.0807 - .0808 

.0903 

.0907 - .0908 




14D 


.0101 

.0103 - .0104 
.0302 - .0303 
.0305 - .0307 
.0310 




14F 


.0004 

.0007 - .0008 

.0010 

.0012 




14G 


.0001 

.0003 - .0004 
.0006- .0016 
.0017 




14II 


.0001 - .0002 
.0003 - .0004 
.0005 
.0006 
.0007 
.0010 

.0012- .0016 
.0018 




141 


.0101 

.0103- .0109 
.0201 - .0205 
.0301 - .0303 




14J 


.0101 - .0106 



Amended 

Repealed 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Repealed 

Amended 

Amended 

Amended 

Amended 

Repealed 

Amended 

Repealed 

Amended 

Amended 

Amended 

Amended 

Repealed 

Amended 

Repealed 

Amended 

Repealed 

Amended 

Amended 

Repealed 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Adopted 

Amended 

Repealed 

Amended 

Repealed 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



NORTH CAROLINA REGISTER 



979 



LIST OF RULES AFFECTED 



.0201 - .0206 
.0301 

.0302 - .0303 
.0304 - .0305 
.0401 
.0403 
14K .0002 

.0004 - .0006 
MinwiFERY JOINT COMMITTKE 



21 NCAC 33 


.0003 




BOARD OF M RSING 






21 NCAC 36 


.0219 
.0223 






.0301 - 


.0304 




.0309 - 


.0310 




.0315 






.0316 






.0317- 


.0318 




.0319 






.0320 




COMMLMTY COLLEGES 







Amended 
Repealed 
Amended 
Repealed 
Amended 
Amended 
Amended 
Amended 



Amended 



Amended 
Amended 
Amended 
Amended 
Amended 
Repealed 
Amended 
Repealed 
Amended 



23 



NCAC 2E .0602 



Amended 



OFFICE OF STATE PERSONNEL 



25 



NCAC IC 


.0302 
.0402 




ID 


.0105 

.0202 

.0205 

.0208 
.0210 

.0302 
.0505 
.1003 

.1005 

.1115 






.1202- 


.1204 




.1401 






.1602 






.1901 - 


.1923 




.1924- 


.1929 




.1931 






.1933- 


.1934 




.1936- 


.1938 




.1942- 


.1944 




.1946- 


.1950 



Amended 
Amended 
Temp. .Amended 
Expires 06-29-89 
Temp. Amended 
Expires 06-29-89 
Temp. Amended 
Expires 06-29-89 
Amended 
Temp. Amended 
Expires 06-29-89 
Amended 
Amended 
Temp. Amended 
Expires 06-29-89 
Temp. Amended 
Expires 06-29-89 
Amended 
Temp. Amended 
Expires 06-29-89 
Amended 
Amended 
Repealed 
Adopted 
Adopted 
Adopted 
Adopted 
Adopted 
Adopted 



980 



NORTH CAROLINA REGISTER 



LIST OF RULES AFFECTED 



.2001 - 


.2004 


IE .0203 




.0204 




.0210 




.0301 




11 .0102 




.0201 




.0203 




.0305 




.0310- 


.0311 


.0313- 


.0315 


.0401 - 


.0402 


.0501 




.0605 




.0702 




.0704 - 


.0707 


.1005 




.1007 




.1009 




.1012 




.1202- 


.1203 


.1206 




.1208- 


.1210 


.1312- 


.1314 


.1405- 


.1406 


.1408- 


.1409 


.1413 




.1507 




.1602 




IJ .0406 - 


.0408 


.0408 




.0605 




.0610- 


.0612 


.0701 




.0801 - 


.0806 


.0808 - 


.0809 


IK .0212 




.0502 




.0605 - 


.0607 


.0609 - 


.0610 


.0705 




IN .0001 




OFFICE OF ADMIMSTRATIVE UKARINGS 


26 NCAC 1 .0001 




2A .0205 




.0210 




.0211 - 


.0212 


.0302 




.0403 




.0405 




2B .0104 




.0203 




3 .0001 - 


.0002 



Adopted 

Temp. Amended 

Expires 06-29-89 

Amended 

Temp. Amended 

Expires 06-29-89 

Temp. Amended 

Expires 06-29-89 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 

Temp. Amended 

Expires 06-29-89 

Amended 

Amended 

Amended 

Amended 

Adopted 

Adopted 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



Amended 

Amended 

Amended 

Adopted 

Amended 

Amended 

Amended 

Amended 

Amended 

Amended 



NORTH CAROLINA REGISTER 



981 



LIST OF RULES AFFECTED 



.0014 Amended 

.0026 Amended 



982 NOR TH CAROLINA REGIS TER 



NC AC INDEX 



TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE 
TITLE DEPARTMENT 



1 

2 

3 

4 

5 

6 

7 

8 

9 
10 
11 
12 
13 
14A 
15 
16 
17 
18 
19A 
20 
*21 
22 
23 
24 
25 
26 



Administration, Department of 

Agriculture, Department of 

Auditor, Department of State 

Commerce, Department of 

Corrections, Department of 

Council of State 

Cultural Resources, Department of 

Elections, State Board of 

Governor, Office of the 

Human Resources, Department of 

Insurance, Department of 

Justice, Department of 

Labor, Department of 

Crime Control and Public Safety, Department of 

Natural Resources and Community Development, Department of 

Education, Department of 

Revenue, Department of 

Secretary of State, Department of 

Transportation, Department of 

Treasurer, Department of State 

Occupational Licensing Boards 

Administrative Procedures 

Community Colleges, Department of 

Independent Agencies 

State Personnel, Office of 

Administrative Hearings, Office of 



NOTE: Title 21 contains the chapters of the various occupational licensing boards. 
CHAPTER LICENSING BOARDS 

2 Architecture, Board of 

4 Auctioneers, Commission for 

6 Barber Examiners, Board of 

8 Certified Public Accountant Examiners, Board of 

10 Chiropractic Examiners, Board of 

12 Contractors, Licensing Board for 

14 Cosmetic Art Examiners, Board of 

16 Dental Examiners, Board of 

18 Electrical Contractors, Board of Examiners of 

20 Foresters, Board of Registration for 

21 Geologists, Board of 

22 Hearing Aid Dealers and Fitters Board 
26 Landscape ^'Vrchitects, Licensing Board of 

28 Landscape Contractors, Registration Board of 

31 Martial & Family Therapy Certification Board 

32 Medical Examiners, Board of 

33 Midwifery Joint Committee 

34 Mortuary Science, Board of 

36 Nursing, Board of 

37 Nursing Home Administrators, Board of 

38 Occupational Therapists, Board of 
40 Opticians, Board of 

42 Optometr)', Board of Examiners in 



NORTH CAROLINA REGISTER 



983 



NC AC INDEX 



44 Osteopathic Examination and Registration, Board of 

46 Pharmacy, Board of 

48 Physical Therapy, Examining Committee of 

50 Plumbing and Heating Contractors, Board of 

52 Podiatry Examiners, Board of 

53 Practicing Counselors, Board of 

54 Practicing Psychologists, Board of 

56 Professional Engineers and Land Surveyors, Board of 

58 Real Estate Commission 

60 Refrigeration Examiners, Board of 

62 Sanitarian Examiners, Board of 

63 Social Work, Certification Board for 

64 Speech and Language Pathologists and 

Audiologists, Board of Examiners of 

66 Veterinary Medical Board 



9S4 NOR TH CAROLINA REGIS TER 



CUMULA TIVE INDEX 



CUMULA TIVE INDEX 

(April 1988 - March 1989) 





1988 - 


1989 




Pages 


1 


[ssue 


1 - 


25 


1 - 


■ April 


26 - 


108 


2 ■ 


■ April 


109 - 


118 


3 - 


■ May 


119 - 


145 


4 ■ 


■ May 


146 - 


184 


5 ■ 


■ June 


185 - 


266 


6 - 


June 


267 - 


294 


7 ■ 


July 


295 - 


347 


8 - 


July 


348 - 


400 


9 - 


■ August 


401 - 


507 


10 ■ 


• August 


508 - 


523 


11 ■ 


• September 


524 - 


593 


12 ■ 


■ September 


594 - 


606 


13 - 


October 


607 - 


686 


14 - 


October 


687 - 


728 


15 - 


• November 


729 - 


799 


16 - 


■ November 


800 - 


833 


17 - 


December 


834 - 


853 


18 - 


■ December 


854 - 


872 


19 - 


■ January 


873 - 


988 


20 - 


January 



AO - Administrative Order 

AG - Attorney General's Opinions 

C - Correction 

E - Errata 

EO - Executive Order 

FDL - Final Decision Letters 

FR - Final Rule 

GS - General Statute 

JO - Judicial Orders or Decision 

LRA - List of Rules Affected 

M - Miscellaneous 

NP - Notice of Petitions 

PR - Proposed Rule 

SO - Statements of Organization 

TR - Temporary Rule 



ADMINISTRATION 

Administrative Analysis Division, 447 PR 

Auxiliary Services, 270 PR 

Departmental Rules, 270 PR 

Human Relations Council, 609 PR 

State Construction, 187 PR, 834 PR 

Youth Advocacy and Involvement Office, 148 PR 



NORTH CAROLINA REGISTER 



985 



CUMULA TIVE INDEX 



ADMIMSTRAITVE HKARINCiS 

General, 579 PR 

llearinas Division, 76 PR, 581 PR 

Rules Division, 580 PR 

706 Deferral. 843 PR 

ADMIMSTRATPV E ORDER 

Administrative Order, 369 AO, 873 AO 

AGRICLLTIRE 

Food and Drug Protection Division, 271 PR 

\.C. Gasoline and Oil Inspection Board, 689 PR 

N.C. Pesticide Board, 524 PR 

N.C. State Fair, 451 PR 

Plant Industrv', 453 PR 

Standards Division, 452 PR 

Structural Pest Control Committee, 296 PR 

COMMERCE 

Alcoholic Be\'erage Control Commission, 276 PR 

Departmental Rules, 612 PR 

Milk Commission, 120 PR, 190 PR 

N.C. State Ports Authority, 731 PR 

Seafood Industrial Park Authority, 613 PR 

COMMLAITV COLLEGES 

Community Colleges. 287 PR, 557 PR 

CORRECTION 

Division of Prisons, 490 FR 

CRLME CONTROL AND PI BLIC SAFETY 

.Alcohol Law Enforcement, 47 PR 

CLLTLRAL RESOURCES 

Division of Archives and History, 691 PR 

EDUCATION 

ElementaPt' and Secondary- Education, 862 PR 



ELECTIONS 






State Board of Flections, 


120 PR 




EXECUTE E ORDERS 






Executive Orders 68 - 


71, 1 


EO 




72, 119 


EO 




73, 146 


EO 


74 - 


75, 508 


EO 


76 - 


77, 594 


EO 




78, 800 


EO 



FINAL DECISION LEH ERS 

Votino Riehts Act, 5 FDL, 26 FDL, 185 FDL, 267 FDL, 295 FDL, 370 FDL, 
401 FDL. 511 FDL, 597 FDL, 608 FDL, 688 FDL, 729 FDL. 801 FDL, 854 FDL, 877 FDL 

GENERAL STATUTES 

Chapter 7A, 348 GS 
Chapter 143B, 350 GS 



9S6 NOR TH CAROLINA REGIS TER 



CUMULA TIVE INDEX 



Chapter 150B, 352 GS 

HUMAN RESOURCES 

Division of Aging, 229 PR 
Drug Commission, 113 FR 

Facility Services, 455 PR, 524 PR, 614 PR, 739 PR 
Health Services, 7 PR, 220 PR, 296 PR, 616 PR, 879 PR 
Medical Assistance, 7 PR, 30 PR, 109 PR, 121 PR, 237 PR, 303 PR, 461 PR 
Mental Hcahh: General, 457 PR, 530 PR, 770 PR 
Mental Health: Hospitals, 459 PR 

Mental Health: Mental Retardation and Substance Abuse Services, 629 PR, 
890 PR 

Mental Health: Other Programs, 530 PR, 
Office of the Secretary, 31 PR 
Services for the Blind, 948 PR 

Social Services Commission, 27 PR, 531 PR, 949 PR 
Vocational Rehabilitation Services, 371 PR 

INDEPENDENT AGENCIES 

Agricultural Finance Authority, 841 PR 

Housing Finance, 21 PR, 134 PR, 255 PR, 518 PR, 839 PR 

INSURANCE 

Agent Services Division, 238 PR, 636 PR 
Company Operations Division, 470 PR 
Consumer Services, 691 PR 
Engineering and Building Codes, 772 PR 
Fire and CasuaUy Division, 32 PR, 461 PR, 773 PR 
Fire and Rescue Services Division, 122 PR, 149 PR 
Life: Accident and Health Division, 534 PR 
Special Services Division, 856 PR 
Support Services Division, 856 PR 

JUSTICE 

Criminal Justice Education and Training Standards, 304 PR 
Private Protective Services, 303 PR, 834 PR 

LABOR 

Boiler and Pressure Vessel, 598 PR 

Elevator and Amusement Device Division, 599 PR 

Notice, 607 C 

Office of Occupational Safety and HeaUh, 598 PR 

LICENSING BOARDS 

Cosmetic Art Flxaminers, 283 PR, 473 PR 

CPA Examiners, 73 PR, 472 PR, 837 PR 

Dental Examiners, 704 PR, 820 PR 

Examiners of Electrical Contractors, 151 PR 

Hearing Aid Dealers, 77 I'R 

Medical Examiners, 838 PR 

Nursing, Board of 376 PR, 477 PR, 704 PR, 965 PR 

Podiatry Examiners, 377 PR 

LIST OE RULES AEEECTED 

April 1, 1988, 102 LRA 
May 1, 1988, 137 LRA 
June 1, 1988, 260 LRA 
July 1, 1988, 335 LRA 
August 1, 1988,496 LRA 



NORTH CAROLINA REGISTER 9S7 



CUMULA TIVE INDEX 



September 1, 1988, 585 LRA 
October 1, 1988, 675 LRA 
November 1, 1988, 790 LRA 
December 1, 1988, 845 LRA 
Januar>- 1, 1989, 976 LRA 

NATURAL RESOURCES AND COMMLAErV DE\ ELOPMENT 

Coastal Manaaement, 11 PR, 67 PR. 254 PR, 281 PR, 703 PR 

Commumty Assistance, 69 PR, 555 PR, 836 PR 

Departmental Rules, 954 PR 

Division of 1-conomic Opportunitv, 556 PR, 778 PR 

Environmental Management, 241 PR, 278 PR, 599 PR, 656 PR, 698 PR, 777 PR 

960 PR 

Lorest Resources, 68 PR 
Marine Fisheries, 62 PR 
Soil and Water Conservation, 1 1 1 PR 
Wildlife Resources and Water Safetv, 111 PR, 282 PR, 470 PR, 513 PR, 555 PR, 

599 PR. 656 PR. 777 PR, 805 PR, 835 PR, 860 PR, 961 PR 

NOTICE OE PETrnON 

Municipal Incorporation, 804 NP 

RE\ENLE 

Departmental Rules, 864 FR 

Individual Income Tax. 710 FR. 825 FR. 864 FR 

License and Excise Tax, 113 FR 

.Motor Fuels Tax, 258 FR 

Sales and Use Taxes, 386 FR, 584 FR. 826 FR 

SECREFAR^ OE STAl E 

Secunties Division. 125 PR. 656 PR 

STATE PERSONNEL 

State Personnel Commission, 135 PR, 333 PR, 559 PR, 781 PR, 971 PR 

STATE TREASURER 

Escheats and Abandoned Property, 328 PR 
Local Government Commission, 18 PR 
Retirement S\stems, 513 PR 

STATEMENTS OE ORGANIZATION 

Statements of Organization, 403 SO 

TRANSPORTATION 

Division of Hiszhways, 719 FR 

Division of Motor Vehicles, 172 FR, 258 FR, 720 FR 



988 NOR TH CAROLINA REGIS TER 



NOW AVAILABLE 



NORTH CAROLINA ADMINISTRATIVE CODE 

The full publication consists of 52 volumes, totaling in excess of J 5,000 pages. It is supplemented monthly 
with replacement pages. A one year .subscription to the full publication including supplements can be 
purchased for seven hundred and fifty dollars ($750.00). Indix'idual volumes may also be purchased with 
supplement service. Renewal subscriptions for supplements to the initial publication available starting 
January I, 1989. 

PRICE LIST FOR THE SUBSCRIPTION YEAR 



V^olume 


Title 


Chapter 


Subject 




New 
Subscription* 


Total 
Quantity Price 


1 - 52 


Full Code 

1 

2 

2 

3 

4 

4 

5 

5 

6 

7 

8 

9 

10 

10 

10 

10 
10 
10 

10 
10 
10 
10 
10 
10 
10 
10 
10 
10 
11 


1 - 37 
1 - 24 
25- 52 
1 -4 
1 - 2 
3- 17 
1 - 2 
3-4 
1 - 4 
1-11 
1 - 9 
1 -4 

I - 2 
3A- 3K 
3L-3R 

3S - 3U 

4-6 

7 

8 - 9 
10 

II - 14 
15- 17 
18 

19 - 30 

31 -33 

34-41 

42 

43 - 50 

1 - 15 


AU titles $750.00 
Administration 90.00 
Agriculture 75.00 
Agriculture 75.00 
Auditor 10.00 
Commerce (includes ABC) 45.00 
Commerce 90.00 
Corrections 60.00 
Corrections 30.00 
Council of State 

Cultural Resources 60.00 
Elections 10.00 
Governor 45.00 
Human Resources 30.00 
Human Resources 90.00 
Human Resources 

(includes CON) 45.00 
Human Resources 30.00 
Human Resources 30.00 
Human Resources 

(includes Breathalizer) 30.00 
Human Resources 60.00 
Human Resources 90.00 
Human Resources 60.00 
Human Resources 45.00 
Human Resources 75.00 
Human Resources 90.00 
Human Resources 30.00 
Human Resources 60.00 
Human Resources 45.00 
Human Resources 90.00 
Insurance 90.00 




1 




2 




3 




4 




5 




6 




7 




8 




9 




10 




11 




12 




13 




14 




15 




16 




17 




18 




19 




20 




21 




22 




23 




24 




25 




26 




27 




28 






Continued 



New Total 

Volume Tille Chapter Subject Subscription* Quantity Price 

1-12 Justice 90.00 

1 - 6 Labor 30.00 

7 OSHA 45.00 

8-15 Labor 45.00 

1-11 Crime Control and 

PubUc Safety 45.00 

1 - 2 NRCD (includes EMC) 90.00 

3 - 6 NRCD 45.00 

7 Coastal Management 45.00 

8 - 9 NRCD 30.00 

10 Wildlife 45.00 

11-22 NRCD 60.00 

1 - 6 Education 30.00 

1 - 6 Revenue 75.00 

7-11 Revenue 60.00 

1 - 7 Secretary of State 30.00 

1 - 6 Transportation 90.00 

1 - 9 Treasurer 45.00 

1-16 Licensing Boards 75.00 

17-37 Licensing Boards 75.00 

38 - 70 Licensing Boards 

1-2 Administrative Procedures 75.00 

1 - 2 Community Colleges 10.00 

1-2 Independent Agencies 10.00 

1 State Personnef 60.00 

1 - 4 Administrative Hearings 10.00 



29 


12 


30 


13 


31 


13 


32 


13 


33 


14A 


34 


15 


35 


15 


36 


15 


37 


15 


38 


15 


39 


15 


40 


16 


41 


17 


42 


17 


43 


18 


44 


19 


45 


20 


46 


21 


47 


21 


48 


21 




22 


49 


23 


50 


24 


51 


25 


52 


26 



Total 



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